Sartipy Fredrik, Lindström David, Gillgren Peter, Ternhag Anders
Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Department of Vascular Surgery, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Ann Vasc Surg. 2014 May;28(4):866-73. doi: 10.1016/j.avsg.2013.11.011. Epub 2014 Jan 16.
After endovascular aortic repair (EVAR) for treatment of aortoiliac aneurysms, patients commonly develop an inflammatory reaction: Postimplantation syndrome (PIS). Clinically, it may be hard to separate PIS from an infectious complication. Procalcitonin (PCT) is a diagnostic marker for severe bacterial infections and sepsis. We hypothesize that low-PCT levels facilitate the PIS diagnosis after EVAR.
Sixty-nine elective EVAR patients were included. Tympanic temperature, C-reactive protein (CRP), white blood cell count (WBC), and PCT were measured on days -1 and +1, +3 and +5. Complications, in-hospital stay, and infections were recorded. PIS was defined by a body temperature of ≥38°C and WBC ≥12,000/μL combined with no other detected complication or surgical event explaining the inflammatory response. Three cohort subgroups were compared: the noncomplication group, those with PIS, and the patients with complications or additional open surgical events.
All patients developed various extents of postoperative inflammatory responses including a rise in WBC, CRP, and/or temperature. PIS was diagnosed in 12 patients. Forty patients had no complication and seventeen suffered complications or had an additional open surgical event. All PIS patients showed low-PCT levels. On day +3, in the PIS group, median PCT was 0.22 ng/mL (95% confidence interval [CI]: 0.15-0.28), WBC 13.2 × 10(9)/L (11.4-15.6), and CRP 196 mg/L (149-243). High PCT was observed in 6 patients, out of which 4 had complications or additional open surgical procedures.
In patients with PIS after EVAR, there was a strong inflammatory reaction. In the PIS condition, PCT remains low. This pilot study shows that PCT may be useful for the PIS diagnosis.
在采用血管腔内主动脉修复术（EVAR）治疗主髂动脉瘤后，患者通常会发生炎症反应：植入后综合征（PIS）。在临床上，可能很难将PIS与感染性并发症区分开来。降钙素原（PCT）是严重细菌感染和脓毒症的诊断标志物。我们推测低PCT水平有助于EVAR术后PIS的诊断。
纳入69例择期行EVAR的患者。在术前1天、术后第1天、第3天和第5天测量鼓膜温度、C反应蛋白（CRP）、白细胞计数（WBC）和PCT。记录并发症、住院时间和感染情况。PIS的定义为体温≥38°C且WBC≥12,000/μL，同时未发现其他可解释炎症反应的并发症或手术事件。比较三个队列亚组：无并发症组、发生PIS的患者组以及发生并发症或进行额外开放手术的患者组。
所有患者均出现不同程度的术后炎症反应，包括WBC、CRP和/或体温升高。12例患者被诊断为PIS。40例患者无并发症，17例患者发生并发症或进行了额外的开放手术。所有PIS患者的PCT水平均较低。在术后第3天，PIS组的PCT中位数为0.22 ng/mL（95%置信区间[CI]：0.15 - 0.28），WBC为13.2×10⁹/L（11.4 - 15.6），CRP为196 mg/L（149 - 243）。6例患者PCT升高，其中4例发生并发症或进行了额外的开放手术。
EVAR术后发生PIS的患者存在强烈的炎症反应。在PIS情况下，PCT仍保持较低水平。这项初步研究表明，PCT可能有助于PIS的诊断。
