Polyester Stent Graft Devices and Higher Risk of Post-Implantation Syndrome after EVAR: Single-Center Analysis of 367 Patients.

BACKGROUND: The post-implantation syndrome may occur shortly after endovascular aneurysm repair in patients treated for abdominal aortic aneurysm. Different types of biomaterials may provoke varying inflammatory responses in patients receiving different endografts. The purpose of this article is to evaluate the PIS after EVAR and the influence of different types of device fabric. METHODS: All patients submitted to elective AAA endovascular repair at our institution from January 2014 to December 2019 were enrolled. The PIS was defined by a body temperature of >38°C and WBC >12'000/µl without any evidence of an infection during (48h) the observation period. RESULTS: Three hundred and sixty-seven patients (89% males) were enrolled in this study and post-implantation syndrome occurred in 41 cases (11.2%). The incidence of PIS was significantly higher (P< 0.001) in patients treated with polyester stent grafts (39/201, 19,4%) compared to patients with PTFE stent grafts (2/166, 1,2%). CRP was related to the presence of PIS with a cut-off values of 109.31 mg/dL (P = 0.0052). The median in-hospital stay considering the polyester group was 6,2 days, while in the PTFE group it was 5,6 days (P = 0.04). CONCLUSIONS: The postoperative inflammatory response after EVAR seems significantly higher by using polyester stent graft compared to PTFE devices. CRP could be a useful biomarker in defining PIS. Multi-center studies are necessary to confirm these data.

The Safety of EVAS Surgical Conversion in a Comparative Monocentric Analysis.

BACKGROUND: Endovascular aneurysm sealing (EVAS) was a widespread technology to treat abdominal aortic aneurysm. However, the particular morphology and structure of this endoprosthesis predisposed to proximal sealing defects with a high rate of reintervention or conversion to open surgery treatments. The purpose of this article is to report our experience on late open conversion of Nellix device, compared with the previous reported experience. MATERIALS AND METHODS: Between September 2013 and February 2020, eight late open surgical conversions for endoleak (EL) were performed in our center: four of these were for EVAR. Four of these were EVAS devices required explantation and were included in the study. All excisions of infected abdominal aortic endograft were excluded. RESULTS: All patients were treated within the original instructions for use. Aorto-bi-iliac reconstruction was performed with a bifurcated Dacron graft in all the four cases. At 12 months Doppler ultrasonography follow-up, good results at short term with preserved primary patency and freedom of re-intervention in three cases were reported. Only one patient died 16 days after the procedure. Nevertheless, the endoprosthetic structure allows in three of our cases to clamp down the renal level, with a decrease of the time of lower limbs ischemia and greater safety of the open surgery repair procedure. CONCLUSIONS: The EVAS conversion is common, and a closer follow-up is required. The most recurrent open surgery indication is its migration and the EL type 1. The procedure is influenced by multiple comorbidities; emergency graft excision appears to increase morbidity and mortality, compared with elective surgical setting.