The Role of Procalcitonin in Postimplantation Syndrome after EVAR: A Pilot Study

BackgroundAfter endovascular aortic repair (EVAR) for treatment of aortoiliac aneurysms, patients commonly develop an inflammatory reaction: Postimplantation syndrome (PIS). Clinically, it may be hard to separate PIS from an infectious complication. Procalcitonin (PCT) is a diagnostic marker for severe bacterial infections and sepsis. We hypothesize that low-PCT levels facilitate the PIS diagnosis after EVAR.MethodsSixty-nine elective EVAR patients were included. Tympanic temperature, C-reactive protein (CRP), white blood cell count (WBC), and PCT were measured on days −1 and +1, +3 and +5. Complications, in-hospital stay, and infections were recorded. PIS was defined by a body temperature of ≥38°C and WBC ≥12,000/μL combined with no other detected complication or surgical event explaining the inflammatory response. Three cohort subgroups were compared: the noncomplication group, those with PIS, and the patients with complications or additional open surgical events.ResultsAll patients developed various extents of postoperative inflammatory responses including a rise in WBC, CRP, and/or temperature. PIS was diagnosed in 12 patients. Forty patients had no complication and seventeen suffered complications or had an additional open surgical event. All PIS patients showed low-PCT levels. On day +3, in the PIS group, median PCT was 0.22 ng/mL (95% confidence interval [CI]: 0.15–0.28), WBC 13.2 × 109/L (11.4–15.6), and CRP 196 mg/L (149–243). High PCT was observed in 6 patients, out of which 4 had complications or additional open surgical procedures.ConclusionsIn patients with PIS after EVAR, there was a strong inflammatory reaction. In the PIS condition, PCT remains low. This pilot study shows that PCT may be useful for the PIS diagnosis.