Long Term Outcomes of Post-Implantation Syndrome After Endovascular Aneurysm Repair

Rita Soares Ferreira, José Oliveira-Pinto, Klaas Ultee, Michiel T. Voûte, Nelson F.G. Oliveira, Sanne Hoeks, Hence J.M. Verhagen, Frederico Bastos Gonçalves*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
5 Downloads (Pure)


Objective: The aim of this study was to investigate the association between post-implantation syndrome (PIS) and long term outcomes, with emphasis on cardiovascular prognosis. Methods: One hundred and forty-nine consecutive patients undergoing EVAR in a tertiary institution were previously included in a study investigating the risk factors and short term consequences of PIS (defined as tympanic temperature ≥ 38°C and CRP > 10 mg/L, after excluding complications with an effect on inflammatory markers). This study was based on a prospectively maintained database. Survival status was derived from inquiry of civil registry database information and causes of death from the Dutch Central Bureau of Statistics. The primary endpoint was cardiovascular events. Secondary endpoints were overall and specific cause mortality (cardiovascular, ischaemic heart disease, AAA, and cancer related mortality). Aneurysm sac dynamics and occurrence of endoleaks were also analysed. Survival estimates were obtained using Kaplan–Meier plots and a multivariable model was constructed to correct for confounders. Results: The PIS incidence was 39% (58/149). At the time of surgery, patients had a mean age of 73 ± 7 years and were predominantly male. There were no baseline differences between the PIS and non-PIS groups. The median follow up was 6.4 years (3.2 – 8.3), similar in both groups (p =.81). There was no difference in cardiovascular events for PIS and non-PIS patients (p =.63). However, Kaplan–Meier plots suggest a trend towards a higher rate of cardiovascular events in PIS patients during the first years: freedom from cardiovascular events at one year was 94% vs. 89% and at three years 90% vs. 82%. No differences were found in overall and specific cause mortality. There was a higher rate of type II endoleaks for non-PIS patients (28% vs. 9%, p =.005). Sac dynamics were similar in both groups. Conclusion: The results suggest that PIS is not associated with a statistically significantly higher risk of cardiovascular events. PIS had no impact on mortality. Lastly, PIS patients had fewer type II endoleaks, but sac dynamics were analogous.

Original languageEnglish
Pages (from-to)561-568
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Issue number4
Early online date27 Aug 2021
Publication statusPublished - Oct 2021

Bibliographical note

Educational research grant from the Lijf en Leven

Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.


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