Pyrexia of postimplantation syndrome for patients undergoing (thoracic) endovascular aortic repair

While a clear definition and explanation to postimplantation syndrome are yet to be clarified, this study aims to investigate its nature by retrospectively analyzing postprocedural fever pattern with patient characteristics, procedure details, and responses to medical treatments.

Twenty-three patients undergoing (thoracic) endovascular aortic repair between January 2011 and January 2012 were studied for their postimplantation fever pattern. The demographic information, procedure specifications, and postprocedure care details were collected for statistical analysis to find associations between fever pattern and the above-mentioned parameters.

None of the postprocedure microbial studies returned positive. Longer fever duration and higher fever frequency are statistically associated with younger age (95% confidence interval [CI] -0.82 to -0.04, p < 0.04 and 95% CI -0.74 to -0.01, p = 0.05 respectively), longer procedure duration (95% CI 0.35-0.90, p < 0.01 and 95% CI 0.02-0.75, p = 0.04 respectively), more entry sites created (95% CI 0.09-0.95 p < 0.03 and 95% CI 0.02-0.88, p < 0.04, respectively), and longer stent grafts implanted (95% CI 0.27-0.89, p < 0.01, fever duration only). Fever pattern and different postprocedure medical treatment did not convey a statistically significant association, but effective and dramatic response to steroids was observed in patients with persistent pyrexia that responded poorly to antibiotics and nonsteroidal anti-inflammatory drugs.

Our findings support the view that postimplantation syndrome is caused by host immune response; none of our cases are related with infection and no benefits were observed from the prolonged use of antibiotics, thus adding to the plausibility of employing steroids as part of the postprocedure care scheme.