De La Motte L, Vogt K, Panduro Jensen L, Groenvall J, Kehlet H, Veith Schroeder T, Lönn L
Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
J Cardiovasc Surg (Torino). 2011 Feb;52(1):73-9.
The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair.
All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurysm during 2007, were retrospectively evaluated for SIRS within the first 5 postoperative days. The only exclusion-criteria were missing data. SIRS was assessed using the criteria defined by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference Committee.
Sixty-six patients were included, 40 (60%) met the SIRS criteria within the first 5 postoperative days (95% of the 40 patients met the criteria within 3 days). We found no significant differences between the SIRS and the non-SIRS group in baseline characteristics or other data including volume of the contrast media used, type of groin access, adjunctive procedures and duration of surgery. In total, 11 (28%) patients in the SIRS group and 4 (15%) patients in the non-SIRS group underwent re-interventions. Median follow-up period was 26 (range 20-32) months. Thirty-day mortality did not differ in the groups (3% in the SIRS group vs. none in the non-SIRS group).
The high incidence of SIRS after EVAR is unexpected considering the minimally invasive procedure. Further studies on the cause of this response and measures to attenuate the response seem appropriate.
本研究旨在评估血管腔内主动脉修复术后植入后综合征/全身炎症反应综合征(SIRS)的发生率。
对2007年接受无症状性肾下腹主动脉瘤择期初次血管腔内修复术的所有患者,在术后第1个5天内进行SIRS的回顾性评估。唯一的排除标准是数据缺失。使用美国胸科医师学会和危重病医学会共识会议委员会定义的标准评估SIRS。
纳入66例患者,40例(60%)在术后第1个5天内符合SIRS标准(40例患者中的95%在3天内符合标准)。我们发现SIRS组和非SIRS组在基线特征或其他数据(包括所用造影剂的量、腹股沟入路类型、辅助操作和手术持续时间)方面无显著差异。SIRS组共有11例(28%)患者和非SIRS组4例(15%)患者接受了再次干预。中位随访期为26(范围20 - 32)个月。两组的30天死亡率无差异(SIRS组为3%,非SIRS组无死亡)。
考虑到该手术的微创性,血管腔内主动脉修复术后SIRS的高发生率出乎意料。对这种反应的原因及减轻该反应的措施进行进一步研究似乎是恰当的。