Post-Implant Syndrome and Outcomes After Fenestrated-Branched Endovascular Aortic Repair
Fernando Motta, MD, Corey A. Kalbaugh, PhD, MS, Charley E. Gaber, MPH, Paula D. Strassle, MSPH, William A. Marston, MD, Martyn D. Knowles, MD, RPVI, Jason R. Crowner, MD, Luigi Pascarella, MD, Katharine L. McGinigle, MD, MPH, Mark A. Farber, MD.
University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
Objectives: Post-implantation syndrome (PIS) may impact outcomes in patients undergoing EVAR. The purpose of this study was to evaluate PIS and its impact on outcomes after F-BEVAR repair of complex aortic aneurysms (CAA).
Methods: Patients who underwent F-BEVAR repair of CAA between July 2012 and July 2017 were retrospectively identified from a prospectively maintained database. Patients were grouped as either PIS (fever >38oC, leukocytosis) or non-PIS. Patients with any factors which could explain leukocytosis were excluded from analysis (n=50). Information obtained included pre-operative demographics, comorbidities, aneurysm characteristics, perioperative data, and follow-up outcomes (early and late mortality, and adverse events). Fisher exact tests and Wilcoxon-Mann-Whitney tests were used to compare groups.
Results: We identified 175 patients during our study period (36 PIS and 139 non-PIS). The mean follow-up for the cohort was 27.8 months (range: 43 days-5.8 years). Patients with PIS were younger than non-PIS (68 vs. 73, years, p =.0027). Hypertension was more common in the non-PIS group (94% vs. 81%[PIS], p=.0024). Aneurysm characteristics were similar in both groups. There was no difference regarding median operative time (296 min vs. 262 min), the volume of contrast (85ml vs. 85ml) and estimated blood loss, (300 ml vs. 300 ml) between the PIS and non-PIS groups. The occurrence of any major adverse events (MAE) was higher in the PIS group (28% vs. 6%, p=.0001), in which the occurrence of respiratory failure was more common (8% vs. 0% [non-PIS], p=.0081) . The length of hospital-stay (in days) was longer in the PIS patients (4.0 vs. 3.0[non-PIS], p=.02). The volume of new aortic thrombus and the presence of type II endoleaks were similar between groups. PIS status was not associated with 1-year higher rates of mortality (11% vs. 8% [non-PIS], p=.51), re-interventions(19% vs. 19%[non-PIS], p=1.0), type II endoleaks (25% vs. 37%[non-PIS], p=.24) or change in aneurysm sac diameter (p=.50).
Conclusion: The presence of PIS did not impact mortality among patients who underwent F-BEVAR aortic repair. However, PIS was associated with a higher incidence of MAE and longer LOS. The volume of newly formed aortic thrombus was not related to the occurrence of PIS. Larger multicenter studies are necessary to confirm our results and to establish a strategy for the management of PIS and determine its impact on long-term outcomes.
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