Interleukin pattern, procalcitonin level and cellular immune response after endovascular repair of abdominal aortic aneurysms

Endovascular repair of AAA's using stent grafts is considered to be a minim ally invasive procedure. However, in some cases deleterious inflammatory re actions, e.g., flu-like postinterventional symptoms are observed. A few pat ients even develop a fatal "postimplantation syndrome". It is not clear whe ther these postoperative complications result from a) the inflammatory and immune response to the inserted graft material, b) alterations of the vascu lar endothelium during the implantation procedure, c) residual thrombotic m aterial, or d) a combination of all these causes. This clinical trial aimed to prospectively investigate the association between inflammatory mediator s like interleukin-l receptor antagonist (IL-1RA), IL-6, and HLA-DR express ion on monocytes and clinical outcome in patients after repair of abdominal aortic aneurysms (AAA). Fifteen patients treated with endovascular stent g rafts for abdominal aortic aneurysm (AAA-E) were compared with 15 selected control patients who underwent a conventional surgical procedure (AAA-K) du ring the same period. Prior to intervention, there were no significant diff erences in marker levels. One hour postoperatively, IL-6 (421 pg/ml vs. 21 pg/ml) and IL-1RA (10061 pg/ml versus 407 pg/ml) were significantly increas ed in the AAA-K-group, whereas in AAA-E patients, these parameters increase d more gradually during the first postoperative day and did not reach the s ame level as in the control group. Then was only a slight reduction of HLA- DR expression in both groups compared with baseline and no signs indicating a postimplantation syndrome were found. No excessive inflammatory response or complicated final outcome were observed. It is unclear if this can be e xplained by the prophylactic use of indometacin.