title: The Impact of Stent Graft Material on the Inflammatory Response After EVAR.
abstract: BACKGROUND
  Patients undergoing endovascular aneurysm repair (EVAR) due to abdominal aortic aneurysm often develop an inflammatory response, postimplantation syndrome (PIS) where fever and leukocytosis are common. Previous studies suggest that type of stent graft material (polyester or polytetrafluoroethylene [PTFE]) plays a role.
  
  
  OBJECTIVE
  To investigate the effect of stent graft material on the inflammatory response and length of hospital stay in patients undergoing standard elective EVAR.
  
  
  METHODS
  Sixty-nine elective EVAR patients were included in this observational study. To avoid comparing patients with a different graft location and stent graft burden, 12 cases were excluded as well as cases with complication or simultaneous open surgical procedures, leaving 45 patients (32 with polyester and 13 with PTFE graft) for final analysis. Tympanic temperature, C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) were measured on days -1 and +1 and +3. Duration of in-hospital stay and frequency of PIS were recorded.
  
  
  RESULTS
  The PIS was diagnosed in 9 (28.1%) of the 32 polyester cases and in 1 (7.7%) of the 13 cases in the PTFE group (P = .24). Median (interquartile range) in-hospital stay was 5 (5-6) days in the polyester group and 4 (4-5) days in the PTFE group (P = .009). On day +3, in the polyester group, mean CRP was 154 (95% confidence interval: 127-182) mg/L, WBC 9.5 (8.4-10.5) ×10(9)/L, and PCT 0.17 (0.12-0.21) ng/mL. In the PTFE group, mean CRP was 70 (32-109) mg/L (P = .001), WBC 8.8 (6.4-11.1) ×10(9)/L (P = .37), and PCT 0.09 (0.06-0.13) ng/mL (P = .009) on day +3.
  
  
  CONCLUSIONS
  Standard EVAR with polyester stent grafts appears to result in a trend toward a more pronounced inflammatory reaction than similar EVAR using PTFE and is associated with a longer in-hospital stay.
authors.affiliation: Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden fredrik.sartipy@gmail.com.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sartipy
authors.affiliation: Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Lindström
authors.affiliation: Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Gillgren
authors.affiliation: Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ternhag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000009:adverse effects*; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; D011138:Polytetrafluoroethylene
keywords: EVAR; inflammatory; material; postimplantation syndrome; procalcitonin; stentgraft