An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm

Abstract

Postimplantation syndrome (PIS) is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR). The goal of this review is to provide an update on the inflammatory response after endovascular repair of abdominal aortic aneurysm, discussing its causes and effects on the clinical outcome of the patient. PIS concerns nearly one-third of patients after EVAR. It is generally a benign condition, although in some patients it may negatively affect outcome. The different definitions and conclusions drawn from several studies reveal that PIS needs to be redefined with standardized diagnostic criteria. The type of the endograft's material seems to play a role in the inflammatory response. Future studies should focus on a better understanding of the underlying pathophysiology, predictors, and risk factors as well as determining whether effective preventive strategies are necessary.

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…61 Thrombin generation, fibrinolysis, platelet and endothelial cell activity, and cytokine release appear immediately after EVAR and a third of patients may develop system inflammatory symptoms. 62,63 . Typical hypovolemia (i.e.…”

Protracted Refractory Pain Post TEVAR: Post Implantation Syndrome?

“…First described in 1999, PIS, is a vaguely defined SIRS following endovascular repair that presents with a noninfectious fever, leukocytosis (>12 000/μl), elevated CRP (>10 mg/L) and coagulation disturbances including thrombocytopenia in the context of negative blood culture results; and occurs in up to 60% patients [4]. Though the exact pathophysiology remains an enigma, it is believed to result from complex endothelial-stent fabric interactions where tissue injury activates complement and induces production of various pro-inflammatory mediators including tumor necrosis factor-α, interleukin (IL)-1, IL-6; with local and systemic effects [4].…”

“…Though the exact pathophysiology remains an enigma, it is believed to result from complex endothelial-stent fabric interactions where tissue injury activates complement and induces production of various pro-inflammatory mediators including tumor necrosis factor-α, interleukin (IL)-1, IL-6; with local and systemic effects [4]. While the systemic effects are well appreciated, and define PIS; there is hardly any mention of its local effects, including local pain.…”

“…It remains a devastating disease with one of the highest mortality rates of cardiovascular diseases and multiple unanswered questions regarding treatment [2]. Endovascular repair of uncomplicated acute aortic Type B dissections (AAD-B) is especially controversial [3] and its associated post-implantation syndrome (PIS) vague [4]. We present a case of a 57-year-old man with an uncomplicated AAD-B managed with TEVAR; and the subsequent refractory pains, only later managed with steroids as atypical PIS.…”

Postimplantation Syndrome after Endovascular Aneurysm Repair

“…In the presence of fever and inflammatory parameters in the early postoperative period, patients usually undergo a work-up for possible infection, typically including chest radiography, urinalysis, urine culture and blood culture [32]. Some argue that this may be costly and unnecessary in clinical absence of an infection source [33].…”