title: Should We be Concerned About the Inflammatory Response to Endovascular Procedures?
abstract: Endovascular surgery represents a minimally invasive procedure for the treatment of occlusive and aneurysmal arterial disease. However, it is followed by inflammatory response, with a rise in specific inflammatory biomarkers, such as C-reactive protein, serum amyloid A and fibrinogen. Shear stress during balloon inflation and vascular injury represents triggering events for the inflammatory process, stimulating the production of proinflammatory molecules and activation of circulating monocytes. The current literature indicates that stent implantation induces more prominent inflammatory reaction. Additionally, it has been shown that muscular arteries of femoropopliteal segment react to a greater extent to stent implantation, compared with elastic carotid or iliac arteries. The endovascular treatment of thoracic and abdominal aortic aneurysm is frequently followed with post-implantation inflammatory syndrome. Most recent findings point out that stent graft material plays a significant role in the inflammatory response, representing a challenge for clinicians. Future studies should consider the pathophysiology of the inflammatory response associated with endovascular procedures as well as predictors and risk factors including preventive strategies and therapeutic algorithms. Although the potential role of anti-inflammatory drugs after endovascular procedures has been observed, it needs to be validated in upcoming trials. The Neutrophil Lymphocyte Ratio, platelet count, Platelet-to-Lymphocyte Ratio and other biomarkers should be considered in future trials to assess the inflammatory response after endovascular procedures. Inflammatory markers may also become therapeutic targets.
authors.affiliation: Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Djordje
authors.initials: D
authors.lastname: Radak
authors.affiliation: Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Djukic
authors.affiliation: Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Tanaskovic
authors.affiliation: Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Obradovic
authors.affiliation: Faculty of Stomatology, Pancevo, University Business Academy, Novi Sad, Serbia.
authors.forename: Desanka
authors.initials: D
authors.lastname: Cenic-Milosevic
authors.affiliation: Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, P.O.Box 522, 11000 Belgrade, Serbia.
authors.forename: Esma R
authors.initials: ER
authors.lastname: Isenovic
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001158:Arteries / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors / Q000378:metabolism*; D012307:Risk Factors; D015398:Signal Transduction; D015607:Stents
chemical_list: D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators
keywords: Endovascular procedures; endovascular aortic repair; inflammatory response; percutaneous transluminal angioplasty; stent implantation; thoracic endovascular aortic repair