Systemic Inflammatory Disease and Its Association With Type II Endoleak and Late Interventions After Endovascular Aneurysm Repair.
OBJECTIVE
Abdominal aortic aneurysms are associated with chronic inflammation within the aortic wall, and previous studies have suggested that chronic inflammation may be a consequence of a dysregulated and persistent autoimmune response. Persistent aortic remodeling after aneurysm repair could place the patient at risk for endoleak or sac rupture.


OBJECTIVE
To determine whether patients with systemic inflammatory disease and large aneurysms have persistent aortic remodeling after endovascular aneurysm repair (EVAR).


METHODS
The records of all patients who underwent EVAR between July 2002 and June 2011 at the Veterans Affairs Connecticut Healthcare System were included in this retrospective review. Patients were considered to have a systemic inflammatory disease when confirmed by a referring specialist. Post-EVAR surveillance was performed by yearly imaging.


METHODS
Endovascular aneurysm repair.


METHODS
Significant endoleak, defined as endoleak and sac diameter increase of 0.5 cm or greater.


RESULTS
A total of 51 of 79 patients (65%) had a systemic inflammatory disease. These patients had similar comorbid conditions compared with patients without inflammation but significantly greater numbers of major postoperative complications after EVAR (23.5% vs 3.6%; P = .02) and overall postoperative complications after EVAR (27.5% vs 7.1%; P = .03). Patients with a history of systemic inflammatory disease developed more endoleaks (45.1% vs 17.9%; P = .02) and late sac expansion (51.0% vs 21.4%; P = .01) and required more interventions (21.6% vs 3.6%; P = .03) during long-term follow-up. Systemic inflammatory disease was significantly associated with significant endoleak (odds ratio, 5.18; 95% CI, 1.56-17.16; P = .007).


CONCLUSIONS
Patients with systemic inflammatory disease are at high risk for postoperative complications, type II endoleak, sac expansion, and additional interventions after EVAR. Additional strategies for improving the efficacy of EVAR in these patients may be warranted.
Department of Surgery, VA Connecticut Healthcare System, West Haven2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Sherif Y
SY
Shalaby
Department of Surgery, VA Connecticut Healthcare System, West Haven2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Trenton R
TR
Foster
Department of Surgery, VA Connecticut Healthcare System, West Haven2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Michael R
MR
Hall
Department of Surgery, VA Connecticut Healthcare System, West Haven2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Kirstyn E
KE
Brownson
Department of Surgery, VA Connecticut Healthcare System, West Haven.
Penny
P
Vasilas
Department of Medicine, VA Connecticut Healthcare System, West Haven4Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Daniel G
DG
Federman
Department of Radiology, VA Connecticut Healthcare System, West Haven6Department of Radiology, Yale University School of Medicine, New Haven, Connecticut.
Hamid R
HR
Mojibian
Department of Surgery, VA Connecticut Healthcare System, West Haven2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Alan
A
Dardik
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D057867:Endoleak / Q000145:classification* / Q000150:complications*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors