Lee Jae Hang, Choi Jin-Ho, Kim Eung-Joong
Department of thoracic and cardiovascular surgery, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, South Korea.
J Cardiothorac Surg. 2018 Apr 12;13(1):27. doi: 10.1186/s13019-018-0712-y.
Although systemic inflammatory responses are common after endovascular aortic repair (EVAR), its etiology remains uncertain. It is normally well tolerated and has a benign course. This study was undertaken to investigate the possible etiology of post-EVAR inflammation by measuring volumes of chronic mural thrombus and fresh thrombus.
The subjects of this study included 34 patients who underwent EVAR from February 2012 to July 2017. Inflammatory markers in all the patients were evaluated before surgery, using the highest value among the laboratory data up to 5 days after surgery, and postoperative computed tomographic angiography (CTA) was taken for all of them before their discharging. Volumes of mural thrombus and fresh thrombus were calculated by CTA. The mean interval from surgery to immediate postoperative CTA was estimated as 6.8 ± 4.0 days.
After undergoing EVAR, white blood cell (WBC) (p < 0.01), C-reactive protein (CRP) (p < 0.01) and erythrocyte sedimentation rate (ESR) (p = 0.01) were significantly elevated. Two groups were defined according to the post-implantation syndrome (PIS) by the criteria of systemic inflammatory response syndrome (SIRS);no significant differences were observed in any factors between the two groups. Classification of two groups by the criteria of increasing WBC and CRP revealed that inflammatory markers were significantly enhanced as the volume of mural thrombus increased (p = 0.03). However, no significant risk factor was found in view of aneurysmal growth after EVAR.
Volume of mural thrombus is an important risk factor for the elevation of inflammatory markers after EVAR.
尽管血管腔内主动脉修复术（EVAR）后全身炎症反应很常见，但其病因仍不确定。它通常耐受性良好，病程良性。本研究旨在通过测量慢性壁血栓和新鲜血栓的体积来探讨EVAR后炎症的可能病因。
本研究的受试者包括2012年2月至2017年7月接受EVAR的34例患者。所有患者在手术前评估炎症标志物，使用术后5天内实验室数据中的最高值，并在出院前对所有患者进行术后计算机断层血管造影（CTA）。通过CTA计算壁血栓和新鲜血栓的体积。手术至术后即刻CTA的平均间隔估计为6.8±4.0天。
接受EVAR后，白细胞（WBC）（p<0.01）、C反应蛋白（CRP）（p<0.01）和红细胞沉降率（ESR）（p=0.01）显著升高。根据全身炎症反应综合征（SIRS）标准的植入后综合征（PIS）定义两组；两组之间在任何因素上均未观察到显著差异。根据WBC和CRP升高标准对两组进行分类显示，随着壁血栓体积增加，炎症标志物显著增强（p=0.03）。然而，在EVAR后动脉瘤生长方面未发现显著危险因素。
壁血栓体积是EVAR后炎症标志物升高的重要危险因素。
