title: Postimplantation syndrome after endovascular aortic repair using the Anaconda™ endograft.
abstract: BACKGROUND
  We report our retrospective experience on postimplantation syndrome (PIS) after the use of Anaconda™ endograft in patients undergoing elective endovascular repair of abdominal aortic aneurysms (EVAR).
  
  
  METHODS
  Data of all patients undergoing elective EVAR between May 2000 and June 2013 using the Anaconda endograft were retrospectively reviewed and the outcomes were analyzed. Preoperative and intraoperative data, any early postoperative complications, length of in-hospital stay, incidence of PIS, and long-term complications were recorded in a database. Patients' quality of life (QOL) was also assessed at 1 month after the procedure. Statistical analysis was performed and P values ≤0.05 were considered statistically significant. Chi-squared tests, log-rank tests, Wilcoxon tests, and Kaplan-Meier survival analysis were performed as appropriate.
  
  
  RESULTS
  Between May 2000 and June 2013, 118 patients (8 female, 6.7%) underwent elective EVAR using the Anaconda endograft. Primary success was obtained in 117 cases (99.1%). Patients were divided into 2 groups based on either the occurrence of PIS (group A: 24 patients, 20.3%) or not (group B). The length of the procedure and the in-hospital stay were longer for group A. One patient from group B died on second postoperative day from myocardial infarction (0.8%). Mean follow-up was 48.4 months (range 5-162 months). Seven endoleaks occurred in the long term regardless of the development of PIS. We did not find any correlation between the presence of PIS and the occurrence of long-term complications, but PIS was correlated to the preoperative burden of thrombus of the aneurysmal sac. On the other side, analysis of QOL surveys showed that patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS.
  
  
  CONCLUSIONS
  In our experience, the occurrence of PIS was related to the duration of the procedure and the preoperative burden of thrombus of the aneurysmal sac. Overall, PIS was a benign complication after EVAR using the Anaconda endograft. However, it affected significantly the length of the in-hospital stay. Moreover, patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS.
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nano
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Occhiuto
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stegher
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Malacrida
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Cova
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Righini
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Domenico G
authors.initials: DG
authors.lastname: Tealdi
authors.affiliation: Operative Unit of Vascular Surgery, First Division, University of Milan, IRCCS Policlinico San Donato, Milan, Italy. Electronic address: danymazzak83@libero.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mazzaccaro
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000523:psychology / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome