A Systematic Review of the Prognostic Value of Inflammatory Biomarkers in Outcomes After Endovascular Abdominal Aortic Aneurysm Repair

Abstract

The present review aimed to evaluate the prognostic value of inflammatory biomarkers in patients undergoing endovascular aortic aneurysm repair (EVAR). A systematic review of relevant studies was performed according to PRISMA guidelines. Articles assessing associations of inflammatory biomarkers with the post-EVAR outcomes were considered. After screening, 34 studies were included (7019 patients were reviewed; mean age: 73.6 years; 91.6% were men); 22 different inflammatory biomarkers were identified among the included studies. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were investigated in 11, 4, and 3 studies, respectively. Nine studies evaluated the post-implantation syndrome (PIS) and examined its role in post-EVAR outcomes. Increased preoperative NLR was associated with all-cause mortality and acute kidney injury after EVAR. NLR was also reported as an independent risk factor for aneurysm sac regression failure. High preoperative PLR and low preoperative LMR were correlated with acute kidney injury and overall mortality, respectively. PIS was associated with a lower type 2 endoleak rate but had no impact on mortality rates. NLR may be a useful predictor for mortality and poor prognosis in EVAR populations. This may have clinical implications in post-EVAR surveillance programs.