Post-implantation syndrome in patients undergoing thoracic and abdominal endovascular aortic repair: Comprehensive systematic review and meta-analysis

Post-implantation syndrome (PIS) can lead to prolonged hospitalization and major adverse cardiovascular events (MACE). This systematic review and meta-analysis investigated the clinical profile of PIS after abdominal (EVAR) and thoracic endovascular aortic repair (TEVAR).

A comprehensive literature search identified 1463 studies, of which 16 (14 retrospective and 2 prospective) met the inclusion criteria. Data from these studies were aggregated using a random effects model to calculate pooled risk ratios and mean differences. The analysis included 2890 patients (males 84.7%, mean age 63.3 years ± 18.8) with 882 experiencing PIS. No significant differences were found in demographics, anthropometric measurements, risk factors, medical history, or chronic medical treatments between the two groups. Fever (above 38°C) was the most frequent clinical manifestation, observed in 75-100% of PIS cases. As expected, higher levels of post-procedural white blood cells (WBC) and platelets (PLT) were shown in PIS patients compared to non-PIS patients. Interestingly, pre-procedural WBC and PLT counts were significantly higher in the PIS group (p<0.001 and p<0.002 respectively). Patients with PIS were more likely to receive polyester graft (p=0.003), while those with polytetrafluoroethylene prostheses were less likely to develop PIS (p=0.04). The PIS group exhibited longer hospital stays compared to the non-PIS group (p<0.001). While most studies reported no evident PIS impact on outcomes, two studies reported higher rate of MACE. Larger prospective studies are needed to determine the optimal management strategies of patients at risk of PIS.