Australia & New Zealand Society of Vascular Surgeons

Introduction Fever is common after endoluminal abdominal aortic aneurysm (eAAA) repair, and may be part of a specific ‘post-implantation’ syndrome. The mechanism remains obscure, but there is a resemblance to the Systemic Inflammatory Response Syndrome (SIRS) which occurs after other physiological insults. We performed a prospective pilot study to investigate the correlation of clinical and procedural parameters with the incidence of SIRS in patients following eAAA. Methods We prospectively collected data regarding patient demographics, vascular anatomy, procedure details and clinical course, with particular study of inflammatory and thrombotic markers collected pre-operatively and during the post-operative period. A routine septic screen consisting of chest X-ray, urinalysis, urine culture and blood cultures was used to investigate any evidence of septic aetiology. Results Eighteen (18) consecutive patients were enrolled in the pilot study. Four patients were excluded due to steroid medication (n=3) or post-operative bacteremia associated with pneumonia (n=1). Of the remaining 14, typical SIRS developed in 7 patients (50%), while 5 patients had fever less than 38oC (35.7%). Only 2 patients remained afebrile (14.3%). The following factors did not effect incidence of SIRS: AAA size, patient age, procedural time, aortic ballooning, contrast volume and use of anti-platelet agents had no significant effect. Patients who developed SIRS had significantly more development of new thrombus (diameter % or cross-sectional area%) within the AAA sac (p<0.05). Conclusions This study supports the existence of an endovascular Systemic Inflammatory Response Syndrome (‘eSIRS’) which occurred in 50% of patients. There is preliminary evidence of an association with large amount of fresh thrombus within the sac. Further studies including more precise volume measurements and parameters of thrombosis are warranted.