Potential reduction in post implant syndrome following total aneurysm sac sealing with Nellix

25 Pages·2017·0.54 MB·English

Potential reduction in post
implant syndrome following total
aneurysm sac sealing with Nellix
Dr. Patrick Berg MD
Kevelaer, Germany
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Disclosure
I have the following potential conflicts of interest to report:
Consulting
X
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Inflammation
• Inflammation is thought to play an important role in the
development and pathogenesis of abdominal aortic aneurysm
(AAA) disease
• The endovascular treatment of AAA (EVAR) induces a systemic
inflammatory response known as “Post-implantation syndrome“
(PIS)
• Several mechanisms are thought to cause PIS after EVAR:
• Injury to the vascular endothelium during endograft implantation
• Manipulation inside the aneurysmal thrombus
• Thrombus burden
• Endograft material
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Purpose of the Study
• to evaluate the risk of post-implantation syndrome (PIS) with
endovascular aneurysm sealing (EVAS) and endovascular
aneurysm repair (EVAR) in patients with abdominal aortic
aneurysm (AAA).
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Methods
• retrospective single-center study
• patients with AAA electively treated with EVAS or EVAR over a
5-year period (January 2011 to December 2015).
• Exclusion criteria: suspected infection, ruptured AAA, prior
EVAR, complex endovascular procedures, need for
concomitant open surgical procedures (e.g. vascular
reconstruction), or use of non-steroidal anti-inflammatory
drugs, cyclo-oxygenase-2 inhibitors, or corticosteroids.
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Methods
• preoperative computed tomography scans to determine
aortoiliac morphology and suitability for endovascular
treatment.
• measurements of aneurysm volume and thrombus volume
– total volume measured by OsiriX MD
– flow lumen volume measured by EndoSize
– thrombus volume by substraction
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Methods
• Main outcomes included:
– body temperature,
– white blood cell (WBC) count,
– CRP concentration
– platelet counts.
• The maximum value for each outcome during the 72-hour
post-procedural period was used for data analysis.
• Post-implant syndrome was defined as temperature >38 C
and WBC count >12.000 / l
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Methods
• Clinical outcomes included major adverse events (MAEs),
cardiovascular MAEs, mortality, and endoleak through 30-day
follow-up.
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Results
• Five-year period: 210 EVAR/EVAS procedures
01.01.11 -31.12.15
AAA excl. criteria
endovascularaorticprocedures: 290 AAA+vascular reconstruction 46
F-EVAR 17
AAA incl. criteria 104 Chimney procedures 15
AAA excl. criteria 106 Symptomatic/ruptured AAA 14
Iliac side branch 8
PAOD 80
EVAR-Repair 3
• 104 patients electively treated
TAA 2
were included in the study. Multi-Branch 1
– EVAR: n=63
– EVAS: n=41
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017
Results
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Potential reduction in PIS following EVAS –Patrick Berg MD LINC Jan 25, 2017