title: Volume of new-onset thrombus is associated with the development of postimplantation syndrome after endovascular aneurysm repair.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of contrast medium volume, inferior mesenteric artery (IMA) patency, and pre-existing as well as new-onset thrombus on the inflammatory response after elective endovascular aneurysm repair (EVAR).
  
  
  METHODS
  The study included 87 patients undergoing elective endovascular repair of asymptomatic infrarenal aneurysms between January 2011 and November 2011. The patency of the IMA was determined by preoperative computed tomography angiography; the volume of the contrast medium used during the procedure was measured, and the volumes of chronic mural as well as new-onset thrombus were calculated from the preoperative and postoperative computed tomography angiograms with dedicated imaging software. The results were correlated to the occurrence of postimplantation syndrome (PIS) as well as to the main clinical and laboratory components of PIS: fever; increased white blood cell (WBC) count and C-reactive protein (CRP) level; decreased platelet count; and increased interleukin (IL)-6, IL-8, and IL-10 levels.
  
  
  RESULTS
  Postoperatively, a statistically significant increase was recorded in the mean values of body temperature, WBCs, CRP, IL-6, IL-8, and IL-10, and a statistically significant decrease was recorded in the number of platelets. After adjustment for endograft type, the volume of new-onset thrombus was found to be significantly correlated with the peak postoperative temperature (β = .307; P < .05) and the increase in WBC count (β = .271; P < .05), CRP level (β = .484; P < .001), and IL-6 level (β = .288; P < .05). On the contrary, the volume of chronic mural thrombus, the patency of the IMA, and the volume of contrast medium were not found to significantly affect any parameter of the PIS. PIS occurred in 34 patients (39%). Multiple logistic regression analysis showed that both the volume of new-onset thrombus and the type of endograft were independently associated with the development of PIS.
  
  
  CONCLUSIONS
  The volume of new-onset thrombus is associated with the development of PIS after EVAR, whereas chronic mural thrombus appears to be an inert material. IMA patency and contrast medium volume are irrelevant to the inflammatory response after EVAR.
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece. Electronic address: kakisis@med.uoa.gr.
authors: John D
authors: JD
authors: Kakisis
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Konstantinos G
authors: KG
authors: Moulakakis
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Constantine N
authors: CN
authors: Antonopoulos
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Spyridon N
authors: SN
authors: Mylonas
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Triantafillos G
authors: TG
authors: Giannakopoulos
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: George S
authors: GS
authors: Sfyroeras
authors: Department of Cytopathology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Petros
authors: P
authors: Karakitsos
authors: Department of Vascular Surgery, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors: Christos D
authors: CD
authors: Liapis
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D001833:Body Temperature Regulation; D003287:Contrast Media; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D010976:Platelet Count; D011237:Predictive Value of Tests; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D018836:Inflammation Mediators