Importance of Biomarkers in Determining Post-Implantation Syndrome Developing Due to Endovascular Aneurysm Repair
Objectives: In this study, we aimed to undertake a systematic review of the literature in order to investigate whether preoperative biomarkers have diagnostic significance in determining post-implantation syndrome PIS possibility after endovascular aneurysm repair (EVAR). Methods: Literature review was carried out in PubMed electronic database without any limitations of date. Included were studies that recorded the preoperative levels of inflammatory biomarkers in which PIS develops following EVAR and that were published only in English. Results of the studies were evaluated based on either random or fixed effect model in accordance with the presence of heterogeneity (I2>25%). Statistical analysis were performed by Open meta Analyst® software. Results: A total of 349 articles were found upon a database screening. After the article titles and abstracts were analysed, 6 articles were included in the meta-analysis that cover 891 patients and comply with inclusion criteria. It was observed in the studies that WBC, CRP, thrombocyte, IL-6, and fibrinogen levels were analysed. It was found from the conducted analysis that the preoperative levels of WBC (SMD: 0.70 95% CI: 0.55-0.86 and p<0.001), fibrinogen (SMD: 0.27 95% CI: 0.03-0.51 and p=0.02), IL-6 (SMD: 1.04 95% CI: 0.64-1.44 and p<0.001), and thrombocyte (SMD: 0.91 95% CI: 0.13-0.69 and p=0.02) were significant in determining the PIS development, however, CRP levels were not (SMD: 0.37 95% CI: -0.20-0.96 and p=0.20). Conclusion: We concluded that WBC, thrombocyte, fibrinogen, and IL-6 levels were effective in predicting PIS developing after EVAR in preoperative period.
Kouvelos GN, Arnaoutoglou E, Giannoukas AD, Matsagkas M. Postimplantation Syndrome: An Underrecognized EVAR Complication. J Endovasc Ther 2017;24:675–6. [CrossRef]
2. Arnaoutoglou E, Kouvelos G, Koutsoumpelis A, Patelis N, Lazaris A, Matsagkas M. An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm. Mediators Inflamm 2015. [CrossRef]
3. Sartipy F, Lindström D, Gillgren P, Ternhag A. The role of procalcitonin in postimplantation syndrome after EVAR: a pilot study. Ann Vasc Surg 2014;28:866–73. [CrossRef]
4. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;1;4:1. [CrossRef]
5. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13. [CrossRef]
6. Arnaoutoglou E, Kouvelos G, Milionis H, Mavridis A, Kolaitis N, Papa N, et al. Post-implantation syndrome following endovascular abdominal aortic aneurysm repair: preliminary data. Interact Cardiovasc Thorac Surg 2011;12:609–14. [CrossRef]
7. Arnaoutoglou E, Kouvelos G, Papa N, Gartzonika K, Milionis H, Koulouras V, et al. Prospective evaluation of postimplantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg 2016;63:1248–55. [CrossRef]
8. Gorla R, Erbel R, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, et al. Clinical features and prognostic value of stent-graftinduced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes. Eur J Cardiothorac Surg 2016;49:1239–47. [CrossRef]
9. Kwon H, Ko GY, Kim MJ, Han Y, Noh M, Kwon TW, et al. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm. Medicine (Baltimore) 2016;95:e4532. [CrossRef]
10. Nano G, Occhiuto MT, Stegher S, Malacrida G, Cova M, Righini P, et al. Postimplantation syndrome after endovascular aortic repair using the Anaconda™ endograft. Ann Vasc Surg 2014;28:1409–15. [CrossRef]
11. Arnaoutoglou E, Kouvelos G, Papa N, Kallinteri A, Milionis H, Koulouras V, et al. Prospective evaluation of post-implantation inflammatory response after EVAR for AAA: influence on patients' 30 day outcome. Eur J VascEndovasc Surg 2015;49:175– 83. [CrossRef]
12. Velázquez OC, Carpenter JP, Baum RA, Barker CF, Golden M, Criado F, et al. Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms. Am J Surg 1999;178:185–9. [CrossRef]
13. Yazman S, Yürekli İ, Yılık L, et al. Our mid-term results of endovascular repair of abdominal aortic aneurysms. Turk Gogus Kalp Dama 2016;24:274–280. [CrossRef]
14. Spanos K, Karathanos C, Giannoukas AD. Redefining the pathophysiology of post-implantation syndrome after endovascular aortic aneurysm repair. Vascular 2017;25:110. [CrossRef]
15. Blum U, Voshage G, Lammer J, Beyersdorf F, Töllner D, Kretschmer G, et al. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med 1997:2;336:13–20.
16. Voûte MT, Bastos Gonçalves FM, van de Luijtgaarden KM, Klein Nulent CG, Hoeks SE, Stolker RJ, et al. Stent graft composition plays a material role in thepostimplantation syndrome. J Vasc Surg 2012;56:1503–9. [CrossRef]
17. Odegård A, Lundbom J, Myhre HO, Hatlinghus S, Bergh K, Waage A, et al. The inflammatory response following treatment of abdominal aortic aneurysms: a comparison between open surgery and endovascular repair. Eur J Vasc Endovasc Surg 2000;19:536–44. [CrossRef]
18. Ikoma A, Nakai M, Sato M, Sato H, Takeuchi H, Tanaka F, et al. Changes in inflammatory, coagulopathic, and fibrinolytic responses after endovascular repair of an abdominal aortic aneurysm: relationship between fibrinogen degradation product levels and endoleaks. Jpn J Radiol 2014;32:347–55. [CrossRef]
19. Arnaoutoglou E, Kouvelos G, Tzimas P, Laou E, Bouris V, Papadopoulos G, et al. Relationship between normal preoperative white blood cell count and major adverse events after endovascular repair for abdominal aortic aneurysm: results of a pilot study. J Clin Anesth 2017;36:201–205. [CrossRef]
20. Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood 2015;30;126:582–8.
21. Kakisis JD, Moulakakis KG, Antonopoulos CN, et al. Volume of new-onset thrombus is associated with the development of postimplantation syndrome after endovascular aneurysm repair. J Vasc Surg 2014;60:1140–5. [CrossRef]
22. Žura M, Kozmar A, Šakić K, Malenica B, Hrgovic Z. Effect of spinal and general anesthesia on serum concentration of proinflammatory and anti-inflammatory cytokines. Immunobiology 2012;217:622–7. [CrossRef]
23. Radak D, Djukic N, Tanaskovic S, Obradovic M, Cenic-Milosevic D, Isenovic ER. Should We be Concerned About the Inflammatory Response to Endovascular Procedures? Curr Vasc Pharmacol 2017;15:230–237. [CrossRef]