Department of Vascular Surgery, "Korgialenio-Benakio" Hospital of Hellenic Red Cross, Athens, Greece.
Department of Vascular Surgery, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Ann Vasc Surg. 2024 Nov;108:375-384. doi: 10.1016/j.avsg.2024.05.024. Epub 2024 Jul 15.
Post implantation syndrome (PIS) is a well-defined entity with unclear etiology, complicating a number of patients with abdominal aortic aneurysms treated with endovascular aortic repair (EVAR). The aim of this study was to assess the platelets' role and the influence of aneurysmal sac thrombus volumes in the development of PIS. A retrospective analysis of prospectively collected data was performed, and 76 patients who were treated by EVAR (2011-2013) were studied. Aneurysms with endoleak were not included in the study. Based on the criteria for systemic inflammatory response syndrome (SIRS), 17 patients (22%) developed PIS (which is considered a SIRS analogue), while 59 (78%) did not.
The 2 groups were compared in relation to the following parameters: baseline platelet count (PLT), decrease of platelet count (PLT drop), volume of the arterial flow before the procedure (V flow), volume of thrombus of the aneurysm (V thromb), ratio of thrombus volume to aneurysm sac volume (V ratio), and the volume of newly formed thrombus (V new). Volume flow measurements were calculated by Osirix software preoperatively and in the first month postoperatively. Parametric and nonparametric techniques (unpaired t-test, Mann-Whitney U test) were used accordingly.
Baseline platelets absolute count was greater in the PIS group (239,000 ± 17,000) versus the non-PIS group (194,000 ± 6,900, P = 0.004), and the PLT drop was larger in the PIS group (74,000 ± 15,600 versus 45,000 ± 5,300, P = 0.019). No difference was found regarding the aneurysm volumes (V flow, V thromb, V ratio, and V new) between the 2 groups.
Platelets, in terms of their absolute baseline count and their decrease after the procedure, seem to be an important factor in developing PIS after EVAR. Further, more tailored studies are needed to elucidate the role of platelets and flow or thrombus volumes in the development of PIS.
植入后综合征（PIS）是一种明确的病症，其病因尚不清楚，会使许多接受血管内主动脉修复术（EVAR）治疗的腹主动脉瘤患者的病情复杂化。本研究旨在评估血小板的作用以及瘤囊血栓体积对 PIS 发展的影响。我们对前瞻性收集的数据进行了回顾性分析，共研究了 76 例接受 EVAR 治疗的患者（2011-2013 年）。本研究不包括存在内漏的动脉瘤。根据全身炎症反应综合征（SIRS）的标准，17 例（22%）患者出现 PIS（被认为是 SIRS 的类似物），59 例（78%）患者未出现 PIS。
比较了两组患者的以下参数：血小板计数基线值（PLT）、血小板计数下降值（PLT 下降值）、术前动脉血流体积（V flow）、瘤囊血栓体积（V thromb）、血栓体积与瘤囊体积比（V ratio）和新形成血栓体积（V new）。术前和术后第一个月使用 Osirix 软件计算血流体积测量值。根据数据分布情况，分别采用参数和非参数检验（配对 t 检验、Mann-Whitney U 检验）。
PIS 组患者的血小板计数基线值绝对值（239,000 ± 17,000）高于非 PIS 组（194,000 ± 6,900，P = 0.004），PIS 组的 PLT 下降值也更大（74,000 ± 15,600 比 45,000 ± 5,300，P = 0.019）。两组患者的动脉瘤体积（V flow、V thromb、V ratio 和 V new）无差异。
就血小板计数基线值绝对值及其术后下降值而言，血小板似乎是 EVAR 后发生 PIS 的一个重要因素。需要进一步进行更有针对性的研究，以阐明血小板以及血流或血栓体积在 PIS 发展中的作用。
