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Endovascular aneurysm sealing blunts systemic inflammatory response vs. repair
In patients with abdominal aortic aneurysm, endovascular aneurysm sealing is associated with a blunted systemic inflammatory response compared with endovascular aneurysm repair, with the greatest periprocedural inflammatory response observed with polyester stent grafts.
Inflammation plays an important role in the development and pathogenesis of AAA, according to Patrick Berg, MD, from the department of vascular and endovascular surgery at the Katholisches Karl-Leisner-Klinikum at Marienhospital Kavelaer, Germany, and colleagues.
“While the initiating factors of inflammatory cascade are not completely understood, once the process has begun, it appears to be self-perpetuating, with progressive aortic degeneration and aneurysm expansion,” Berg and colleagues wrote in the Journal of Endovascular Therapy. “An important mediator of the inflammatory cascade is intraluminal thrombus, which may trigger a systematic inflammatory response and influence postoperative outcomes following EVAR.”
Berg and colleagues conducted a single-center, retrospective study to evaluate the risk for postimplantation syndrome associated with endovascular aneurysm sealing (EVAS) and EVAR in patients who underwent treatment for AAA.
The study included 104 patients with AAA. Of those, 41 underwent EVAS with the Nellix system (Endologix) and 63 underwent EVAR, most commonly with the Anaconda (Vascutek), Excluder (W.L. Gore and Associates) and Endurant/2 (Medtronic) devices, from December 2013 to May 2015.
The main study outcomes were postimplantation syndrome, which was defined as temperature higher than 38°C; inflammatory response markers, including platelets and high-sensitivity C-reactive protein; and clinical complications through 30 days.
According to the results, patients who underwent EVAS, compared with EVAR, had lower rates of postimplantation syndrome (5.1% vs. 20.5%; P = .07), mean body temperature (37.2°C vs. 37.6°C; P = .05), mean leukocyte count (10.8 x 103/µL vs. 13.8 x 103/µL; P = .003) and mean high-sensitivity CRP (7.2 mg/L vs. 15.2 mg/L; P < .001). Platelet count was not different after EVAS or EVAR.
At 30 days, serious adverse events (0% vs. 12.8%; P = .05) and endoleaks (0% vs. 10.3%; P = .05) were less common in the EVAS group. Cardiac decompensation, secondary intervention for type I endoleaks and angina pectoris with elevated troponin were the most common serious adverse events in the EVAR group. Moreover, rates of 30-day serious adverse events were higher in patients with postimplantation syndrome vs. those without (20% vs. 4%).
“While no cause-and-effect relationship can be determined in this study due to a limited sample size, these preliminary results suggest a possible relationship between systemic inflammation and complication risk in the perioperative period following endovascular AAA treatment,” the researchers wrote.
Choice of endovascular graft material was associated with postoperative and 30-day clinical outcomes, the researchers reported. Patients treated with polyester stent grafts had increased temperature, white blood cell count and high-sensitivity CRP levels, and the overall rate of postimplantation syndrome was higher with this type of graft compared with polytetrafluoroethylene stent grafts (30.8% vs. 0%; P = .005).
Procedure time and length of hospital stay were similar with EVAS and EVAR.
“Overall, these results suggest that graft composition and complete AAA sac thrombus sealing influence the systematic inflammatory response following endovascular AAA treatment. – by Dave Quaile
Disclosures: Berg and another author report consulting for Endologix.