Post Implantation Syndrome and Administration on NSAIDs in Patients Undergoing EVAR for AAA
Status:
Unknown status
Trial end date:
2021-10-01
Target enrollment:
Participant gender:
Summary
INTRODUCTION Post-implantation syndrome is the clinical and biochemical expression of an
inflammatory response following endovascular repair of an aortic aneurysm. PIS is mainly a
clinical condition associated with the implantation of an endograft and is diagnosed by the
presence of fever accompanied by elevated WBC count above normal without any evidence of an
infection.
The correlation between the type of the endograft placed and the development of PIS may
indicate that the inflammatory reaction is due to the material of the endograft itself (
polyester or PTFE ). Based on the results of different studies the type of endograft's
material seems to play an important role in PIS development and may have a predictive role
for a significant number of patients undergoing endovascular repair of abdominal aortic
aneurysm (EVAR).
In most studies PIS is considered a benign condition, although it may lead to a more
demanding postoperative care characterized by prolonged hospitalization. In an other
prospective study patients with PIS were more likely to suffer from an adverse event during
the 30 days after the procedure. The occurrence of PIS was the only independent predictor of
a MACE ( major cardiovascular events ) or an adverse event during the follow-up period.
Current available literature data certainly raise the question of altering current approach
and treat patients with PIS by focusing on the reduction of the inflammatory response by
administration of steroid or non-steroidal drugs.
The aim of the present randomized placebo-controlled study is to evaluate whether the
perioperative administration of Naproxen (NPR) an anti-inflammatory drug with a beneficial
cardiovascular safety profile in patients with an abdominal aortic aneurysm undergoing
endovascular repair could have any effect on the inflammatory response and patients outcome
during the first year of follow-up after the surgery.
METHOD PIS will be considered as the presence of fever (persisting body temperature > 38 ° C
lasting more than 1 day during hospitalization) and leukocytosis ( white blood cell count >
12,000 / mL ) with negative blood and urine culture. All patients with AAA that will be
subjected to EVAR in our department since February 2018 and who will receive an endograft
made from polyester will be included in this study.
All patients after being informed pre-operatively about the way and the purpose of the
clinical study, the patients will be randomly selected to receive either naproxen ( NPR ) 500
mg x 2 or placebo, starting the previous day before the procedure and for 3 days
postoperatively. The NPR was selected due to the expected significant anti-inflammatory
activity and favorable cardiovascular safety profile.
All patients presenting with fever during the post-operative period, whether or not
fulfilling the PIS criteria, will undergo a thorough work up for possible infection. If any
of these tests reveal evidence of an early pulmonary, urinary tract or any other kind of
infection, the patient will not be considered to suffer from PIS. Patients will be discharged
in the absence of any complications, with a body temperature < 38oC for at least 24 hours and
a WBC < 12.000/mL.
Besides the traditional inflammatory markers (WBC, hs-CRP, and fibrinogen ) the investigators
will also measure interleukin 6 (IL-6) because it was the only marker significantly altered
in PIS patients in a previous study.
The follow-up will be performed at 1, and 12 months after surgery. Patient quality of life
will also be studied by completing the SF36 questionnaire preoperatively and in the first
year post-operative follow-up.