Perigraft air, fever, and leukocytosis rafter endovascular repair of abdominal aortic aneurysms

BACKGROUND: The postimplantation syndrome of fever and leukocytosis after e ndovascular repair of infrarenal aortic aneurysms has not been previously c haracterized and its etiology is not known. METHODS: We studied the first 12 patients who underwent successful endovasc ular repair of infrarenal aortic aneurysms with Dacron-covered stent-grafts , as part of an ongoing phase II clinical trial. Sepsis syndrome evaluation s (physical examination, urinalysis, chest radiograph, urine cultures, and blood cultures) were performed for all patients with postoperative temperat ure (T) greater than 101.4 degrees F, Computed tomography scans of the abdo men were performed, as part of the clinical protocol, on postoperative days 2 and 30, RESULTS: Fever (T > 101.4 degrees F) was seen in 8 of 12 (67%) patients (P < 05), An additional 2 of 12 (17%) patients had low-grade fevers (100.3 deg rees F, 100.6 degrees F). Only 2 of 12 (17%) patients remained afebrile pos toperatively. Leukocytosis with counts over 11,000 white blood cells (WBC) /dL was observed in 7 of 12 (58%) patients (P < 05), Sepsis evaluations fai led to identify any source of infection in 11 of 12 (97%) patients. Compute d tomograhy scan evidence of perigraft air was noted in 8 of 12 (67%) patie nts. All patients were afebrile, had normal white blood cell counts, and we re discharged within 1 week postoperatively. There has been no evidence of graft infection after 1 to 6 months of follow-up. CONCLUSIONS: Fever and leukocytosis after stent-graft repair of aortic aneu rysms does not represent evidence of systemic or graft infection and is not clearly related to nonspecific causes of postoperative fever and leukocyto sis, Moreover, the finding of early postoperative perigraft air is not nece ssarily an indication of graft infection even when concurrently present wit h fever and leukocytosis. (C) 1999 by Excerpta Medica, Inc.