1 Department of Vascular & Endovascular Surgery, Katholisches Karl-Leisner-Klinikum, Marienhospital Kevelaer, Kevelaer, Nordrhein-Westfalen, Germany.
2 Miller Scientific Consulting, Inc, Asheville, NC, USA.
J Endovasc Ther. 2017 Oct;24(5):670-674. doi: 10.1177/1526602817722019. Epub 2017 Jul 24.
To evaluate the risk of postimplantation syndrome associated with endovascular aneurysm sealing (EVAS) and endovascular aneurysm repair (EVAR) in patients treated for abdominal aortic aneurysm (AAA).
From December 2013 to May 2015, 41 AAA patients treated with EVAS (mean age 72±9 years; 38 men) and 63 with EVAR (mean age 74±10 years; 55 men) at a single center were retrospectively reviewed. To control for treatment selection bias, propensity score matching was used to compare outcomes by treatment mode. Main outcomes were postimplantation syndrome (defined as temperature >38°C and leukocyte count >12,000/µL), inflammatory response markers [platelets and high-sensitivity C-reactive protein (hs-CRP)], and clinical complications through 30 days.
In 39 matched patients per group, the incidences of postimplantation syndrome (p=0.07), mean body temperature (p=0.05), mean leukocyte count (p=0.003), and mean hs-CRP (p<0.001) were proportionally lower with EVAS vs EVAR. Serious adverse events (0% vs 12.8%, p=0.05) and endoleaks (0% vs 10.3%, p=0.13) through 30 days were less frequent with EVAS, but the group differences were not significantly different. The choice of endovascular graft material influenced postoperative and 30-day clinical outcomes, with greater overall risk observed with polyester stent-grafts.
Endovascular aneurysm sealing is associated with a blunted systematic inflammatory response compared with EVAR. Polyester stent-grafts induce the greatest periprocedural inflammatory response.
评估血管内动脉瘤封闭（EVAS）和血管内动脉瘤修复（EVAR）治疗腹主动脉瘤（AAA）患者术后综合征的风险。
2013 年 12 月至 2015 年 5 月，回顾性分析在单中心接受 EVAS（平均年龄 72±9 岁；38 名男性）和 EVAR（平均年龄 74±10 岁；55 名男性）治疗的 41 例 AAA 患者和 63 例患者的临床资料。为了控制治疗选择偏倚，采用倾向评分匹配法比较不同治疗方式的结果。主要观察终点为术后综合征（定义为体温>38°C 和白细胞计数>12,000/µL）、炎症反应标志物[血小板和高敏 C 反应蛋白（hs-CRP）]和 30 天内的临床并发症。
在每组 39 例匹配患者中，EVAS 组的术后综合征发生率（p=0.07）、平均体温（p=0.05）、平均白细胞计数（p=0.003）和平均 hs-CRP（p<0.001）均低于 EVAR 组。EVAS 组严重不良事件（0% vs 12.8%，p=0.05）和 30 天内内漏（0% vs 10.3%，p=0.13）的发生率低于 EVAR 组，但差异无统计学意义。血管内移植物材料的选择影响术后和 30 天的临床结局，聚酯支架移植物的总风险更高。
与 EVAR 相比，血管内动脉瘤封闭术引起的系统性炎症反应较轻。聚酯支架移植物引起的围手术期炎症反应最大。
