Arnaoutoglou E, Kouvelos G, Papa N, Kallinteri A, Milionis H, Koulouras V, Matsagkas M
Department of Anesthesiology, School of Medicine, University of Ioannina, Ioannina, Greece.
Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece.
Eur J Vasc Endovasc Surg. 2015 Feb;49(2):175-83. doi: 10.1016/j.ejvs.2014.12.006. Epub 2015 Jan 9.
The aim was to prospectively evaluate post-implantation syndrome (PIS) after elective endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) and to investigate its association with clinical and laboratory parameters and the clinical outcome of the patients.
From January 2010 till June 2013, 214 consecutive patients treated electively by EVAR for AAA were prospectively included. PIS was defined according to systemic inflammatory response syndrome criteria. Adverse events included any major adverse cardiovascular events (MACE), acute renal failure, re-admission and death from any cause.
PIS was diagnosed in 77 (34%) patients. Pre-operative white blood cell (WBC) count values (p < .001), endograft material (polyester) (p < .001), and heart failure (p = .03) were independent predictors of PIS. Mean post-operative temperature (p < .001), length of hospital (p < .001) and intensive care unit (p = .008) stay, as well as maximum post-operative WBC count (p < .001) and hs-CRP values (p < .001) were significantly higher in the PIS group. Post-operative hs-CRP (p = .001) and duration of fever (p = .02) independently predicted the occurrence of MACE. Post-operative hs-CRP (p = .004), maximum temperature (p = .03), and the presence of PIS (p = .01) were independent predictors of an adverse event during the first 30 days. A threshold of post-operative hs-CRP value of 125 mg/L was highly associated with the occurrence of MACE, with a sensitivity of 82% and specificity of 75%.
A systematic inflammatory response is observed in a significant number of patients after EVAR. The type of endograft material seems to play a significant role in this inflammatory process. The intensity of inflammation, as assessed mainly by the post-operative hs-CRP values, correlates with the presence of a cardiovascular or any other adverse event during the first 30 days after the procedure.
旨在前瞻性评估腹主动脉瘤（AAA）择期血管内动脉瘤修复术（EVAR）后的植入后综合征（PIS），并研究其与临床和实验室参数以及患者临床结局的关联。
2010年1月至2013年6月，前瞻性纳入214例连续接受EVAR治疗AAA的择期患者。PIS根据全身炎症反应综合征标准定义。不良事件包括任何主要不良心血管事件（MACE）、急性肾衰竭、再次入院和任何原因导致的死亡。
77例（34%）患者被诊断为PIS。术前白细胞（WBC）计数（p <.001）、人工血管材料（聚酯）（p <.001）和心力衰竭（p =.03）是PIS的独立预测因素。PIS组术后平均体温（p <.001）、住院时间（p <.001）和重症监护病房停留时间（p =.008），以及术后最高WBC计数（p <.001）和高敏C反应蛋白（hs-CRP）值（p <.001）均显著更高。术后hs-CRP（p =.001）和发热持续时间（p =.02）独立预测MACE的发生。术后hs-CRP（p =.004）、最高体温（p =.03）和PIS的存在（p =.01）是术后30天内不良事件的独立预测因素。术后hs-CRP值阈值为125 mg/L与MACE的发生高度相关，敏感性为82%，特异性为75%。
大量患者在EVAR术后出现系统性炎症反应。人工血管材料的类型似乎在这一炎症过程中起重要作用。主要通过术后hs-CRP值评估的炎症强度与术后30天内心血管或任何其他不良事件的发生相关。
