Review Article

Cytokines as biomarkers of inflammatory response after open versus endovascular repair of abdominal aortic aneurysms: a systematic review

Diamantis I TSILIMIGRAS1, Fragiska SIGALA1, Georgios KARAOLANIS2, Ioannis NTANASIS-STATHOPOULOS2, Eleftherios SPARTALIS3, Michael SPARTALIS4, Nikolaos PATELIS2, Alexandros PAPALAMPROS2, Chandler LONG5, Demetrios MORIS5
1 First Department of Propaedeutic Surgery, Hippokration University Hospital, University of Athens Medical School, Athens, Greece
2 First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
3 Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greec
4 Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
5 Department of Surgery, Duke University Medical Center, Durham, NC, USA
Correspondence to: Demetrios MORIS:,
DOI: 10.1038/aps.2017.212
Received: 5 November 2017
Accepted: 31 December 2018
Advance online: 17 May 2018


The repair of an abdominal aortic aneurysm (AAA) is a high-risk surgical procedure related to hormonal and metabolic stress-related response with an ensuing activation of the inflammatory cascade. In contrast to open repair (OR), endovascular aortic aneurysm repair (EVAR) seems to decrease the postoperative stress by offering less extensive incisions, dissection, and tissue manipulation. However, these beneficial effects may be offset by the release of cytokines and arachidonic acid metabolites during intra-luminal manipulation of the thrombus using catheters in endovascular repair, resulting in systemic inflammatory response (SIR), which is clinically called post-implantation syndrome. In this systematic review we compared OR with EVAR in terms of the post-interventional inflammatory response resulting from alterations in the circulating cytokine levels. We sought to summarize all the latest evidence regarding post-implantation syndrome after EVAR. We searched Medline (PubMed), and the Cochrane library for clinical studies reporting on the release of cytokines as part of the inflammatory response after both open/conventional and endovascular repair of the AAA. We identified 17 studies examining the cytokine levels after OR versus EVAR. OR seemed to be associated with a greater SIR than EVAR, as evidenced by the increased cytokine levels, particularly IL-6 and IL-8, whereas IL-1β, IL-10 and TNF-α showed conflicting results or no difference between the two groups. Polyester endografts appear to be positively correlated with the incidence of post-implantation syndrome after EVAR. Future large prospective studies are warranted to delineate the underlying mechanisms of the cytokine interaction in the post-surgical inflammatory response setting.
Keywords: abdominal aortic aneurysms (AAA); open repair (OR); endovascular repair (EVAR); surgical stress; cytokines

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