The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm

Abstract

Objective: To evaluate the impact of endograft type on the inflammatory response after elective endovascular repair of abdominal aortic aneurysms. Methods: From January 2011 to November 2011, we included 100 consecutive patients who underwent elective abdominal aortic aneurysm endovascular repair. Thirteen patients were excluded from the analysis: four with cancer, three with autoimmune disease, two because of recent infection, two who were receiving long-term anti-inflammatory medication, and two because of recent surgery. Temperature, white blood cell count, platelet count, and serum concentrations of cytokines (interleukin [IL]-6, IL-8, and IL-10) were measured preoperatively, 24 hours postoperatively, and 48 hours postoperatively. The study sample was divided into four groups with respect to the type of endograft used: group A, n [

Prospective Evaluation of Post-implantation Inflammatory Response After EVAR for AAA: Influence on Patients' 30 Day Outcome

“…This finding is in accordance with the recent publication of Voûte et al 8 However, in the same report the authors showed that the implantation of stent grafts based on polyester was independently associated with a stronger inflammatory response. 8 Moulakakis et al, 9 observing a milder inflammatory activation in patients with a PTFE endograft, have confirmed this finding in a later report. In accordance with these reports it was found that the use of polyester endograft independently predicted PIS and was correlated with a greater than 10 times higher risk for an inflammatory response.…”

“…In EVAR cases, the amount of contrast media, the endograft material, or the amount of mural thrombus within the aneurysm sac have all been implied as possible causative factors. 8,9,20,21 The type of anesthesia may also have a role by influencing the inflammatory cytokine response. 22 As most of the patients worldwide are operated on under general anesthesia, to avoid any possible bias all patients in this study were operated on under general anesthesia.…”

“…23 A significant decrease in platelet count, an indirect index of platelet activation and consumption, has been observed postoperatively in a substantial proportion of EVAR patients. 3,9 The amount of mural thrombus has also been proposed to incur a role in the inflammatory response, as PIS initially was linked with the release of inflammatory mediators from the aneurysm thrombus. 15,16 Kakisis et al 24 recently evaluated nearly 85 patients after EVAR and reported an association between new onset thrombus and PIS.…”

“…In most studies PIS is generally well tolerated, showing a benign course during the post-operative period. 9 Most series have failed to demonstrate any connection between PIS and postoperative complications. 9,14 However, no study so far has focused on cardiovascular and other adverse events, by prospectively evaluating the treated patients during the 30 day post-operative period.…”

“…Other groups have also investigated possible factors that may influence PIS after EVAR. Voûte et al 8 found that polyester stent grafts were independently associated with an increased risk of PIS, while Moulakakis et al 9 confirmed these results in a later report. However, the association between PIS and patient outcome, including cardiovascular or other adverse events, has not been prospectively investigated in any study so far.…”