Acute inflammatory reaction associated with endoluminal bypass grafts.
OBJECTIVE
Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation.


METHODS
Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group.


RESULTS
In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1 beta and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 +/- 2.8 versus 90.2 +/- 34.1 pg/mL and 15.6 +/- 5.8 versus 175.5 +/- 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 +/- 0.2 versus 5.0 +/- 0.2 g/L; p < 0.05) and C-reactive protein (14.6 +/- 3.3 versus 77.5 +/- 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation.


CONCLUSIONS
The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.
Hayoz
D
D
Division of Vascular Medicine, University Hospital, Lausanne, Switzerland.
Do
D D
DD
Mahler
F
F
Triller
J
J
Spertini
F
F
D000368:Aged; D000497:Alloys; D000783:Aneurysm / Q000601:surgery*; D001012:Aorta, Abdominal; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005263:Femoral Artery; D005549:Foreign-Body Reaction / Q000209:etiology*; D006801:Humans; D008297:Male; D011091:Polyesters; D011183:Postoperative Complications / Q000209:etiology*; D015607:Stents / Q000009:adverse effects; D014654:Vascular Patency
D000497:Alloys; D016207:Cytokines; D011091:Polyesters