Zusammenfassung
Hintergrund
Ziel der vorliegenden Umfrage war es, den Stellenwert des Postimplantationssyndroms (PIS) nach endovaskulärer Ausschaltung (EVAR) infrarenaler Aortenaneurysmen [Bauchaortenaneurysmen (BAA)] in der deutschen Gefäßchirurgie zu evaluieren.
Material und Methoden
Anhand eines standardisierten Fragebogens wurden von Januar 2012 bis April 2012 insgesamt 124 gefäßchirurgische Kliniken in Deutschland zu ihrer Erfahrung mit PIS befragt. Erfasst wurden die EVAR-Häufigkeit pro Klinik, verwendete Stentgraftsysteme, die PIS-Inzidenz, angelegte Diagnosekriterien, die Therapie und die klinische Relevanz des PIS.
Ergebnisse
Die auswertbare Rücklaufquote betrug 59,7 % (74/124). In 70,2 % (52/74) der Kliniken lag die Anzahl der EVAR-Prozeduren bei ≥ 25/Jahr. Die Inzidenz des PIS wird von 70,2 % (52/74) mit ≤ 20 % angegeben. Führende Diagnosekriterien waren eine Körpertemperatur ≥ 38,5°C, eine Leukozytose ≥ 12/nl und ein Spiegel des C-reaktiven Proteins (CRP) von 50–100 mg/l. Für 55,4 % (41/74) der Kliniken stellt das PIS keine relevante Komplikation nach EVAR dar. Die Therapie des PIS erfolgt uneinheitlich mit nichtsteroidalen Antiphlogistika.
Schlussfolgerung
Die klinische Relevanz des PIS ist nach wie vor unklar. Das Fehlen definierter Diagnosekriterien erschwert eine genauere Erfassung der PIS-Inzidenz. Vor dem Hintergrund der aktuell limitierten Datenlage bezüglich Ätiologie und Pathogenese, der subjektiven Belastung der betroffenen Patienten sowie der unbekannten Langzeitfolgen ist eine weitere wissenschaftliche Aufarbeitung des PIS indiziert.
Abstract
Background
To evaluate the role of the postimplantation syndrome (PIS) after endovascular repair (EVAR) of infrarenal aortic aneurysms (AAA) in German vascular surgery practice.
Materials and methods
From January 2012 to April 2012, a total of 124 German departments for vascular surgery were surveyed regarding their experience with PIS using a standardized questionnaire. Categories were EVAR frequency per year, stent graft devices used, PIS incidence, diagnostic criteria for PIS, treatment of PIS, and relevance of PIS as a complication after EVAR.
Results
The analyzable return rate was 59.7 % (74/124). In 70.2 % (52/74), the number of EVAR procedures performed was ≥ 25/year. The incidence of PIS was estimated to occur in ≤ 20 % of cases by 70.2 % (52/74). The diagnostic cut-off values used were body temperature ≥ 38.5 °C, white blood cell count ≥ 12/nl, and C-reactive protein levels of 50–100 mg/l. A variety of non-steroidal anti-inflammatory drugs were used for treatment. For 55.4 % (41/74) of the participating centers, PIS does not represent a relevant complication after EVAR. PIS is nonuniformly treated with nonsteriodal anti-inflammatory agents.
Conclusion
The clinical relevance of PIS is still unclear. The lack of defined diagnostic criteria makes it difficult to determine the exact incidence of PIS. Due to the currently limited data on PIS etiology and pathogenesis, the impact on long-term outcome is unknown and the individual burden of patients suffering PIS requires further research.
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Interessenkonflikt. M.S. Bischoff, S. Hafner, T. Able, A.S. Peters, A. Hyhlik-Dürr und D. Böckler geben an, dass kein Interessenkonflikt besteht.
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Bischoff, M., Hafner, S., Able, T. et al. Inzidenz und Therapie des Postimplantationssyndroms nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen. Gefässchirurgie 18, 381–387 (2013). https://doi.org/10.1007/s00772-013-1193-x
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DOI: https://doi.org/10.1007/s00772-013-1193-x