Acute Inflammatory Reaction Associated with Endoluminal Bypass Grafts

Abstract

Purpose: Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation. Methods: Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group. Results: In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1β and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 ± 2.8 versus 90.2 ± 34.1 pg/mL and 15.6 ± 5.8 versus 175.5 ± 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 ± 0.2 versus 5.0 ± 0.2 g/L; p < 0.05) and C-reactive protein (14.6 ± 3.3 versus 77.5 ± 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation. Conclusions: The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.