Clinical implications of systemic inflammatory response syndrome following thoracic aortic stent-graft placement

To quantify inflammatory markers in a large cohort of patients undergoing thoracic endovascular aortic repair (TEVAR) and investigate if profound biomarker elevations may be predictors of postprocedural death.

We analyzed data from 103 patients (70 men; mean age 64.5+/-11.2 years, range 22-83) undergoing TEVAR between July 1999 and December 2006. Baseline as well as at least 3 serial measurements of C-reactive protein (CRP), fibrinogen, white blood cell (WBC) count, and D-dimers were performed within the first 20 days after TEVAR.

Compared with baseline, all inflammatory biomarker levels rose significantly. WBC peaked 2 days after the procedure, whereas CRP, fibrinogen, and D-dimers showed a sustained elevation up to 20 days after TEVAR. Inflammatory responses were more pronounced in patients with acute aortic pathology compared with chronic aortic diseases. There was evidence of greater increase in biomarkers with an increasing number of stent-grafts implanted. Kaplan-Meier analysis suggested that increasing maximum D-dimer values postoperatively were associated with decreased survival after TEVAR (p=0.036) in a subset of patients; however, multivariate analysis failed to identify postinterventional biomarker elevation as independent predictor of in-hospital death.

Postprocedural inflammatory responses characterized by elevations of CRP, fibrinogen, D-dimers, and WBC are observed in all patients undergoing TEVAR. Our data indicate that this response is more pronounced in patients with acute aortic pathology and those receiving >1 stent-graft.