Konstantinos G. Moulakakis1, Maria Alepaki2, Giorgos S. Sfyroeras1, Triantafillos G. Giannakopoulos1, Constantinos N. Antonopoulos1, John Kakisis1, Anastasios Papapetrou1, Petros Karakitsos2, Christos D. Liapis1
1Department of Vascular Surgery, University of Athens, Attikon Hospital, Greece, Athens, Greece; 2Department of Cytopathology, University of Athens, Attikon Hospital, Greece, Athens, Greece.
OBJECTIVES: The aim of this prospective study was to evaluate the impact of endograft type on the inflammatory response after elective endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs).
METHODS: From January 2011 to November 2011, 100 consecutive patients underwent elective AAA endovascular repair. Fever, white blood cells, platelets, serum concentrations of cytokines (interleukin 6, 8 and 10, TNFa), were measured preoperatively, 24 and 48 hours postoperatively. Thirteen patients were excluded from the analysis (4 due to cancer, 3 with autoimmune disease, 2 because of recent infection, 2 patients receiving chronic antiinflammatory medication and 2 because of surgery two months prior to enrollment). Patients were divided into 4 groups according to the endograft used: group A, n=28 (Anaconda, Sulzer Vascutek), group B, n=26 (Zenith, Cook Inc.), group C, n=23 (Excluder, W.L. Gore) and group D, n=10 Endurant (Medtronic, Inc.).
RESULTS: Epidemiological characteristics, atherosclerotic risk factors, type of anesthesia, mean blood loss during surgery and baseline serum levels of cytokines did not differ among the patients of the four groups. Mean temperature was more pronounced postoperatively in group A. Serum levels of IL-6, and IL-10 were significantly higher 24 and 48 hours postoperatively compared to preoperative levels in all groups. Patients in Group C presented the smallest increase in levels of serum IL-6, and IL-10, 24 and 48 hours postoperatively. Mean difference in cytokines levels after aneurysm exclusion was higher for group A vs. C (p<0.01) compared to group A vs. B (p<0.05). Increased inflammatory response was associated with prolonged hospital stay.
CONCLUSIONS: Endograft type appears to influence the inflammatory response following EVAR. The impact of postimplantation inflammatory response in clinical outcomes requires further investigation.
AUTHOR DISCLOSURES: M. Alepaki, Nothing to disclose; C. N. Antonopoulos, Nothing to disclose; T. G. Giannakopoulos, Nothing to disclose; J. Kakisis, Nothing to disclose; P. Karakitsos, Nothing to disclose; C. D. Liapis, Nothing to disclose; K. G. Moulakakis, Nothing to disclose; A. Papapetrou, Nothing to disclose; G. S. Sfyroeras, Nothing to disclose.
Posted April 2012