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Clinical Outcome and Morphologic Determinants of Mural Thrombus in Abdominal Aortic Endografts

2015-06Journal article Open access
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dc.contributor.authorOliveira, N
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorHoeks, S
dc.contributor.authorTen Raa, S
dc.contributor.authorUltee, K
dc.contributor.authorRouwet, E
dc.contributor.authorHendriks, J
dc.contributor.authorVerhagen, H
dc.date.accessioned2015-10-23T14:47:23Z
dc.date.available2015-10-23T14:47:23Z
dc.date.issued2015-06
dc.description.abstractOBJECTIVE: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.pt_PT
dc.identifier10.1016/j.jvs.2015.01.032
dc.identifier.citationJ Vasc Surg. 2015 Jun;61(6):1391-8pt_PT
dc.identifier.doi10.1016/j.jvs.2015.01.032
dc.identifier.urihttp://hdl.handle.net/10400.17/2316
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectHSM CIR VASCpt_PT
dc.subjectAortic Aneurysm, Abdominal/diagnosispt_PT
dc.subjectAortic Aneurysm, Abdominal/mortalitypt_PT
dc.subjectAortic Aneurysm, Abdominal/surgerypt_PT
dc.subjectAortography/methodspt_PT
dc.subjectBlood Vessel Prosthesis/adverse effectspt_PT
dc.subjectBlood Vessel Prosthesis Implantation/adverse effectspt_PT
dc.subjectBlood Vessel Prosthesis Implantation/instrumentationpt_PT
dc.subjectBlood Vessel Prosthesis Implantation/mortalitypt_PT
dc.subjectChi-Square Distributionpt_PT
dc.subjectDatabases, Factualpt_PT
dc.subjectDisease-Free Survivalpt_PT
dc.subjectEndovascular Procedures/adverse effectspt_PT
dc.subjectEndovascular Procedures/instrumentationpt_PT
dc.subjectEndovascular Procedures/mortalitypt_PT
dc.subjectGraft Occlusion, Vascular/diagnosispt_PT
dc.subjectGraft Occlusion, Vascular/etiologypt_PT
dc.subjectImaging, Three-Dimensionalpt_PT
dc.subjectKaplan-Meier Estimatept_PT
dc.subjectLogistic Modelspt_PT
dc.subjectMultivariate Analysispt_PT
dc.subjectOdds Ratiopt_PT
dc.subjectPortugalpt_PT
dc.subjectPredictive Value of Testspt_PT
dc.subjectProsthesis Designpt_PT
dc.subjectRadiographic Image Interpretation, Computer-Assistedpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Factorspt_PT
dc.subjectStents/adverse effectspt_PT
dc.subjectTertiary Care Centerspt_PT
dc.subjectThrombosis/diagnosispt_PT
dc.subjectThrombosis/etiologypt_PT
dc.subjectTime Factorspt_PT
dc.subjectTomography, X-Ray Computedpt_PT
dc.subjectTreatment Outcomept_PT
dc.titleClinical Outcome and Morphologic Determinants of Mural Thrombus in Abdominal Aortic Endograftspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1398pt_PT
oaire.citation.startPage1391pt_PT
oaire.citation.titleJournal of Vascular Surgerypt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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