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Original Investigation
Association of VA Surgeons
February 2016

Systemic Inflammatory Disease and Its Association With Type II Endoleak and Late Interventions After Endovascular Aneurysm Repair

Author Affiliations
  • 1Department of Surgery, VA Connecticut Healthcare System, West Haven
  • 2Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
  • 3Department of Medicine, VA Connecticut Healthcare System, West Haven
  • 4Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 5Department of Radiology, VA Connecticut Healthcare System, West Haven
  • 6Department of Radiology, Yale University School of Medicine, New Haven, Connecticut
JAMA Surg. 2016;151(2):147-153. doi:10.1001/jamasurg.2015.3219

Importance  Abdominal aortic aneurysms are associated with chronic inflammation within the aortic wall, and previous studies have suggested that chronic inflammation may be a consequence of a dysregulated and persistent autoimmune response. Persistent aortic remodeling after aneurysm repair could place the patient at risk for endoleak or sac rupture.

Objective  To determine whether patients with systemic inflammatory disease and large aneurysms have persistent aortic remodeling after endovascular aneurysm repair (EVAR).

Design, Setting, and Participants  The records of all patients who underwent EVAR between July 2002 and June 2011 at the Veterans Affairs Connecticut Healthcare System were included in this retrospective review. Patients were considered to have a systemic inflammatory disease when confirmed by a referring specialist. Post-EVAR surveillance was performed by yearly imaging.

Intervention  Endovascular aneurysm repair.

Main Outcomes and Measures  Significant endoleak, defined as endoleak and sac diameter increase of 0.5 cm or greater.

Results  A total of 51 of 79 patients (65%) had a systemic inflammatory disease. These patients had similar comorbid conditions compared with patients without inflammation but significantly greater numbers of major postoperative complications after EVAR (23.5% vs 3.6%; P = .02) and overall postoperative complications after EVAR (27.5% vs 7.1%; P = .03). Patients with a history of systemic inflammatory disease developed more endoleaks (45.1% vs 17.9%; P = .02) and late sac expansion (51.0% vs 21.4%; P = .01) and required more interventions (21.6% vs 3.6%; P = .03) during long-term follow-up. Systemic inflammatory disease was significantly associated with significant endoleak (odds ratio, 5.18; 95% CI, 1.56-17.16; P = .007).

Conclusions and Relevance  Patients with systemic inflammatory disease are at high risk for postoperative complications, type II endoleak, sac expansion, and additional interventions after EVAR. Additional strategies for improving the efficacy of EVAR in these patients may be warranted.