Department of Vascular Surgery, University of Athens, Attikon Hospital, Athens, Greece.
J Vasc Surg. 2013 Mar;57(3):668-77. doi: 10.1016/j.jvs.2012.09.034. Epub 2013 Jan 11.
To evaluate the impact of endograft type on the inflammatory response after elective endovascular repair of abdominal aortic aneurysms.
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 = 28 (Anaconda; Sulzer Vascutek, Bad Soden, Germany); group B, n = 26 (Zenith; Cook Inc, Bloomington, Ind); group C, n = 23 (Excluder; W. L. Gore and Assoc, Flagstaff, Ariz); and group D, n = 10 (Endurant; Medtronic, Minneapolis, Minn). Endograft configurations included bifurcated grafts only.
Epidemiologic characteristics, atherosclerotic risk factors, type of anesthesia, mean blood loss during surgery, and baseline serum levels of cytokines did not differ among the four groups. Mean elevated temperature was more pronounced postoperatively in group A. Serum levels of IL-6 and IL-10 were significantly higher 24 hours and 48 hours postoperatively compared with preoperative levels in all groups. Patients in group C showed the smallest increase in levels of serum IL-6 and IL-10 at 24 hours and 48 hours postoperatively. Mean difference in cytokine levels after aneurysm exclusion was greater for group A vs group C (P < .01) compared with group A vs B (P < .05). No differences in the mortality and morbidity rates were observed among the four groups.
Endograft type appears to influence the inflammatory response after endovascular aortic repair. The postimplantation syndrome was apparent during the first 24 hours and decreased afterward. Anaconda and Zenith endografts induced a more intense inflammatory response. A "milder" inflammatory activation was observed in patients with an Excluder endograft. The postimplantation syndrome was not associated with perioperative adverse clinical events showing a benign course. The possible long-term sequelae of postimplantation syndrome require further investigation.
评估腹主动脉瘤腔内修复术（endovascular repair of abdominal aortic aneurysms，EVAR）中使用不同覆膜支架对炎症反应的影响。
本研究回顾性分析 2011 年 1 月至 2011 年 11 月期间 100 例行 EVAR 的患者，排除合并恶性肿瘤、自身免疫性疾病、近期感染、长期应用抗炎药物、近期手术的患者，共 13 例。根据使用的支架类型分为 4 组：A 组（Anaconda，Sulzer Vascutek，Bad Soden，德国）28 例，B 组（Zenith，Cook Inc，Bloomington，Ind）26 例，C 组（Excluder，W. L. Gore and Assoc，Flagstaff，Ariz）23 例，D 组（Endurant，Medtronic，Minneapolis，Minn）10 例。所有患者均采用全身麻醉，支架均为分叉型。分别于术前、术后 24 h、术后 48 h 检测体温、白细胞计数、血小板计数和细胞因子（白细胞介素-6、白细胞介素-8、白细胞介素-10）浓度。
4 组患者的流行病学特征、动脉粥样硬化危险因素、麻醉方式、手术失血量、细胞因子基线水平比较差异均无统计学意义。A 组术后体温升高更明显。术后 24 h、48 h 各细胞因子水平较术前均明显升高，差异有统计学意义（均 P<0.05）。术后 24 h、48 h C 组白细胞介素-6、白细胞介素-10 水平升高幅度最小，与 A 组比较差异均有统计学意义（均 P<0.01），与 B 组比较差异亦有统计学意义（均 P<0.05）。4 组患者死亡率和并发症发生率比较差异均无统计学意义。
覆膜支架的类型可能影响 EVAR 后的炎症反应，支架植入后综合征在术后 24 h 内明显，之后逐渐减轻。Anaconda 和 Zenith 支架引起更强烈的炎症反应，Excluder 支架引起的炎症反应较轻。支架植入后综合征与围手术期不良临床事件无关，表现为良性过程。支架植入后综合征的长期后果尚需进一步研究。
