Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/2316
Título: Clinical Outcome and Morphologic Determinants of Mural Thrombus in Abdominal Aortic Endografts
Autor: Oliveira, N
Bastos Gonçalves, F
Hoeks, S
Ten Raa, S
Ultee, K
Rouwet, E
Hendriks, J
Verhagen, H
Palavras-chave: HSM CIR VASC
Aortic Aneurysm, Abdominal/diagnosis
Aortic Aneurysm, Abdominal/mortality
Aortic Aneurysm, Abdominal/surgery
Blood Vessel Prosthesis/adverse effects
Blood Vessel Prosthesis Implantation/adverse effects
Blood Vessel Prosthesis Implantation/instrumentation
Blood Vessel Prosthesis Implantation/mortality
Chi-Square Distribution
Databases, Factual
Disease-Free Survival
Endovascular Procedures/adverse effects
Endovascular Procedures/instrumentation
Endovascular Procedures/mortality
Graft Occlusion, Vascular/diagnosis
Graft Occlusion, Vascular/etiology
Imaging, Three-Dimensional
Kaplan-Meier Estimate
Logistic Models
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Risk Factors
Stents/adverse effects
Tertiary Care Centers
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Data: Jun-2015
Editora: Elsevier
Citação: J Vasc Surg. 2015 Jun;61(6):1391-8
Resumo: OBJECTIVE:Endograft mural thrombus has been associated with stent graft or limb thrombosis after endovascular aneurysm repair (EVAR). This study aimed to identify clinical and morphologic determinants of endograft mural thrombus accumulation and its influence on thromboembolic events after EVAR. METHODS: A prospectively maintained database of patients treated by EVAR at a tertiary institution from 2000 to 2012 was analyzed. Patients treated for degenerative infrarenal abdominal aortic aneurysms and with available imaging for thrombus analysis were considered. All measurements were performed on three-dimensional center-lumen line computed tomography angiography (CTA) reconstructions. Patients with thrombus accumulation within the endograft's main body with a thickness >2 mm and an extension >25% of the main body's circumference were included in the study group and compared with a control group that included all remaining patients. Clinical and morphologic variables were assessed for association with significant thrombus accumulation within the endograft's main body by multivariate regression analysis. Estimates for freedom from thromboembolic events were obtained by Kaplan-Meier plots. RESULTS: Sixty-eight patients (16.4%) presented with endograft mural thrombus. Median follow-up time was 3.54 years (interquartile range, 1.99-5.47 years). In-graft mural thrombus was identified on 30-day CTA in 22 patients (32.4% of the study group), on 6-month CTA in 8 patients (11.8%), and on 1-year CTA in 17 patients (25%). Intraprosthetic thrombus progressively accumulated during the study period in 40 patients of the study group (55.8%). Overall, 17 patients (4.1%) presented with endograft or limb occlusions, 3 (4.4%) in the thrombus group and 14 (4.1%) in the control group (P = .89). Thirty-one patients (7.5%) received an aortouni-iliac (AUI) endograft. Two endograft occlusions were identified among AUI devices (6.5%; overall, 0.5%). None of these patients showed thrombotic deposits in the main body, nor were any outflow abnormalities identified on the immediately preceding CTA. Estimated freedom from thromboembolic events at 5 years was 95% in both groups (P = .97). Endograft thrombus accumulation was associated with >25% proximal aneurysm neck thrombus coverage at baseline (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3), neck length ≤ 15 mm (OR, 2.4; 95% CI, 1.3-4.2), proximal neck diameter ≥ 30 mm (OR, 2.4; 95% CI, 1.3-4.6), AUI (OR, 2.2; 95% CI, 1.8-5.5), or polyester-covered stent grafts (OR, 4.0; 95% CI, 2.2-7.3) and with main component "barrel-like" configuration (OR, 6.9; 95% CI, 1.7-28.3). CONCLUSIONS: Mural thrombus formation within the main body of the endograft is related to different endograft configurations, main body geometry, and device fabric but appears to have no association with the occurrence of thromboembolic events over time.
Peer review: yes
URI: http://hdl.handle.net/10400.17/2316
DOI: 10.1016/j.jvs.2015.01.032
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