Protracted refractory pain post-TEVAR: post-implantation syndrome?
Aortic dissection is a life-threatening condition and has one of the highest mortality rates of cardiovascular diseases. It remains a devastating disease; with multiple unanswered questions concerning treatment modalities. The role of thoracic endovascular aortic repair (TEVAR) in these patients; especially those with uncomplicated acute aortic Type B dissections (AAD-B) is especially controversial although it has been shown to have better long-term outcomes compared to medical therapy alone. For those who have TEVAR, up to 60% may develop an acute, transient systemic inflammatory response syndrome that remains vaguely defined. The role of local inflammation in this post-implantation syndrome (PIS) has not been highlighted. We present a case of a 57-year-old male patient with an uncomplicated AAD-B who developed an 'atypical' PIS post-TEVAR with severe refractory abdominal pains; leukocytosis and raised C-reactive protein. The role of local inflammation in PIS is highlighted.
Department of Surgery , MP Shah Hospital , Nairobi, Nairobi-Kenya.
Peter
P
Waweru
Department of Vascular Surgery , MP Shah Hospital, PO Box 14497-00800, Nairobi ,  Nairobi-Kenya.
Hardeep
H
Gill
Department of Internal Medicine/Nephrology , MP Shah Hospital, PO Box 14497-00800, Nairobi , Nairobi-Kenya.
Chris
C
Abeid