目的:植入后综合征(PIS)是血管内主动脉修复(EVAR)后的早期全身炎症反应。患者的反应是可变的,PIS对结果的临床意义未知。本研究旨在评估发病率,PIS的危险因素和预后意义。
方法:根据PubMed的PRISMA和Cochrane指南进行了系统的文献回顾和分析,Scopus,ClinicalTrials.gov和Cochrane中央对照试验登记册。纳入了关于肾下EVAR后PIS的合格英语研究,删除重复项之后。
结果:筛选后,包括31项研究。共有2,847名患者接受了审查,平均年龄为70.7岁,其中2012年(90.4%)为男性,合并平均随访26.1个月.在25.3%的平均动脉瘤直径为56.4cm的病例中报告了PIS。1839年,794名患者(27.9%)使用聚酯(64.6%)使用了PTFE移植物。WBC,CRP,术后IL-6、IL-8和IL-10水平均显著升高。30天的结果包括I型内漏率为0.8%,II型内漏1.7%,再干预0.35%,死亡率0.25%。PIS患者(309例)与非PIS患者(691例)的亚组汇总分析显示,聚酯(642例),而不是PTFE(234)移植物,与较高的PIS率相关(94.8%与3.7%;p=0.0001),PIS组术前WBC计数均较高(7.61vs.6.76;p=0.04)和术后(15.0vs.9.8;p=0.0007),PIS组术后IL-6水平较高(98.6vs.25.2;p=0.02)。动脉瘤直径和动脉瘤囊内慢性或新血栓的数量未被确定为PIS的危险因素。PIS患者的汇总结果与无PIS显示30天死亡率显著较高(0.6%vs.0%;p=0.03)和主要不良心脏事件(5.8%vs.0.43%;p<0.0001)在再干预方面没有任何差异,30天I型或II型内漏。
结论:本系统综述表明,与PTFE相比,聚酯移植物与PIS密切相关。有趣的是,本报告提示30日死亡率与主要不良心脏事件和PIS之间存在关联.鉴于这些临床后遗症,考虑在聚酯移植物上使用PTFE来减少PIS的发生率可能是改善总体结果的简单步骤。Further,探索与PIS相关的炎症介质与死亡率和心脏并发症之间的关系可能会导致对风险的更深入理解,最终减轻PIS患者的伤害。
OBJECTIVE: Post implantation syndrome (PIS) is an early systemic inflammatory response following endovascular aortic repair (EVAR). The response is variable in patients and the clinical significance of PIS upon outcomes is unknown. This study aims to evaluate the incidence, risk factors, and prognostic implication of PIS.
METHODS: Systematic literature
review and analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines of PubMed, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Eligible English-language studies regarding PIS after infrarenal EVAR were included, after removing duplicates.
RESULTS: After screening, 31 studies were included. A total of 2847 patients were reviewed, with mean age of 70.7 years, of which 2012 (90.4%) were male, with a pooled mean follow-up of 26.1 months. PIS was reported in 25.3% of cases, with mean aneurysm diameter of 56.4 cm. Polytetrafluoroethylene (PTFE) grafts were utilized in 794 patients (27.9%) with polyester in 1839 (64.6%). White blood cell count, C-reactive protein, interleukin (IL)-6, IL-8, and IL-10 levels were all significantly elevated postoperatively. Thirty-day outcomes included type I
endoleak rate of 0.8%, type II
endoleak rate of 1.7%, reintervention rate of 0.35%, and mortality rate of 0.25%. Subgroup pooled analysis of patients with PIS (n = 309) vs No-PIS (n = 691) revealed that polyester (n = 642), rather than PTFE (n = 234) grafts, were associated with a higher rate of PIS (94.8% vs 3.7%; P = .0001), White blood cell count was higher in the PIS group both preoperatively (7.61 vs 6.76 × 109/L; P = .04) and postoperatively (15.0 vs 9.8 × 109/L; P = .0007) and IL-6 levels were higher in the PIS group postoperatively (98.6 vs 25.2 pg/mL; P = .02). Aneurysm diameter and amount of chronic or new thrombus within the aneurysm sac was not identified as a risk factor for PIS. Pooled outcomes of patients with PIS vs No-PIS demonstrated a significantly higher rate of 30-day mortality (0.6% vs 0%; P = .03) and major adverse cardiac events (5.8% vs 0.43%; P < .0001) without any differences seen in reintervention or 30-day type I or type II endoleaks.
CONCLUSIONS: This systematic
review suggests that polyester grafts are strongly associated with PIS compared with PTFE. Interestingly, this report is suggestive of an association between 30-day mortality and major adverse cardiac events and PIS. Given these clinical sequelae, consideration for use of PTFE over polyester grafts to reduce the incidence of PIS may be a simple step to improve overall outcome. Further, exploration of the relationship between inflammatory mediators associated with PIS and mortality and cardiac complications may engender deeper understanding of risks, leading to eventual mitigation of harm for patients experiencing PIS.