Ribeiro Tiago F, Soares Ferreira Rita, Amaral Carlos, Bastos Gonçalves Frederico, Ferreira Maria Emília
Hospital de Santa Marta, Unidade Local de Saúde São José, Lisbon, Portugal.
NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal.
EJVES Vasc Forum. 2025 Mar 5;64:34-41. doi: 10.1016/j.ejvsvf.2025.02.005. eCollection 2025.
Post-implantation syndrome (PIS), a systemic inflammatory response following endovascular aneurysm repair (EVAR) is estimated to occur in approximately 30% of patients. It has been hypothesised to resemble a hypersensitivity reaction. A secondary exposure after a priming event could result in an altered risk and severity of PIS. This study aimed to determine the incidence and short-term clinical consequences of PIS after secondary endovascular aortic aneurysm interventions.
Single centre retrospective observational study. Between 2011 and 2022, all consecutive patients who underwent secondary elective endovascular aortic interventions following a primary elective EVAR, thoracic endovascular aneurysm repair, or fenestrated and branched EVAR were considered. Re-interventions occurring within the first 30 post-operative days were excluded. PIS was defined as tympanic temperature ≥38°C and C-reactive protein (CRP) > 75 mg/L. Primary outcome was PIS incidence within three days. Secondary outcomes were short-term (30 days) outcomes and risk factors for PIS. Logistic regression analysis was performed to correct for confounders.
Seventy nine secondary interventions in 71 patients who underwent elective primary repair were analysed. During secondary repair, shorter stent graft combinations (median 305 171 mm, ≤ 0.001) were implanted. In addition, patients were older (70 73 years, = 0.043) and more frequently taking statin (79.4 92.2%, = 0.026) or antiplatelet agents (66.7 85.6 %, = 0.010). Overall, PIS occurred in 24.0%, significantly lower following secondary repair (32.3% 16.5%, = 0.022, adjusted odds ratio 0.38, 95% confidence interval 0.16-0.89). There were no significant differences in highest recorded temperature ( = 0.25), days of fever ( = 0.44), CRP, or peak white blood cell count. CRP presented a more delayed elevation in secondary PIS.
After secondary endovascular aortic interventions, PIS incidence appears reduced compared with primary aortic repair. This should be interpreted with caution, in the context of procedural heterogeneity and limited number of cases. Further studies to confirm these findings and explore the underlying immunological mechanisms are required.
植入后综合征（PIS）是血管内动脉瘤修复术（EVAR）后发生的一种全身炎症反应，估计约30%的患者会出现。据推测，它类似于一种超敏反应。初次事件后的二次暴露可能会改变PIS的风险和严重程度。本研究旨在确定二次血管内主动脉瘤干预后PIS的发生率和短期临床后果。
单中心回顾性观察研究。纳入2011年至2022年间，所有在初次择期EVAR、胸段血管内动脉瘤修复术或开窗及分支EVAR后接受二次择期血管内主动脉干预的连续患者。排除术后30天内发生的再次干预。PIS定义为鼓膜温度≥38°C且C反应蛋白（CRP）>75mg/L。主要结局是三天内PIS的发生率。次要结局是短期（30天）结局和PIS的危险因素。进行逻辑回归分析以校正混杂因素。
分析了71例接受择期初次修复患者的79次二次干预。在二次修复期间，植入的支架移植物组合较短（中位数305±171mm，P<0.001）。此外，患者年龄更大（70±73岁，P=0.043），更频繁服用他汀类药物（79.4%±92.2%，P=0.026）或抗血小板药物（66.7%±85.6%，P=0.010）。总体而言，PIS发生率为24.0%，二次修复后显著降低（32.3%±16.5%，P=0.022，调整后的优势比0.38，95%置信区间0.16-0.89）。最高记录温度（P=0.25）、发热天数（P=0.44）、CRP或白细胞计数峰值无显著差异。二次PIS中CRP升高出现得更延迟。
二次血管内主动脉干预后，PIS发生率似乎低于初次主动脉修复。鉴于手术的异质性和病例数量有限，对此应谨慎解读。需要进一步研究来证实这些发现并探索潜在的免疫机制。
