Abstract 17109: New Insight into the Post Implantation Syndrome after Endovascular Therapy in Patients with Acute Aortic Syndromes
Background: Post implantation syndrome (PIS) represents an unexpected systemic inflammatory response syndrome (SIRS) after endovascular therapy in patients with aortic diseases. Aim of our study is to evaluate the incidence and biomarkers profile of PIS in patients undergoing thoracic endovascular aortic repair (TEVAR) of acute aortic syndromes (AAS).
Methods: Clinical and laboratory data of 146 consecutive TEVAR patients (86 type B acute aortic dissection [TB-AAD], 34 type B intramural hematoma [TB-IMH] and 26 penetrating aortic ulcer [PAU]) were prospectively collected from 2000 to 2014. Diagnostic criteria of PIS were fever > 38°C + leucocytes (WBC) > 12.0/nl + C reactive protein (CRP) > 10 mg/dl within 3 days after the procedure, despite negative culture results. Blood levels of fibrinogen (FBG), D-dimer (D-D) and interleukin 6 (IL-6) were also determined. Chi-square test and Students t-test were applied as appropriate.
Results: PIS was diagnosed in 14% of patients (14% in TB-AAD, 15% in TB-IMH and 12% in PAU). Preoperative levels of the biomarkers were not significantly different between PIS and non-PIS patients. Within 3 days after TEVAR, PIS patients showed significantly higher peak values of WBC, CRP, D-D and IL-6, compared to non-PIS patients. Similarly, the time course from TEVAR to discharge revealed sustained higher biomarkers levels in the PIS group (Table 1). Non significant differences were noted regarding in hospital complications rate (malperfusion [15% vs. 20%; p=0,56], cerebrovascular accident [10% vs. 7,1%; p=0,64], stent endoleak [20% vs. 9,5%; p=0,16]), mortality (0,0% vs. 6,2%; p=0,22) and length of stay (26,2 ± 15,2 vs. 26,2 ± 19,7; p=1,00) in PIS and non-PIS group respectively.
Conclusions: PIS may occur in up to 14% of AAS patients after TEVAR. Patients with PIS develop within 72 h after TEVAR a SIRS which is more striking and prolonged as compared to non-PIS patients. Further studies are needed to fully explore the prognostic implications of PIS.
Author Disclosures: R. Gorla: None. E. Bossone: None. K. Tsagakis: None. P. Kahlert: None. H. Jacob: None. R. Erbel: None. R.A. Janosi: None.
- © 2014 by American Heart Association, Inc.