Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair

Ben Li; Janice Montbriand; Naomi Eisenberg; Graham Roche-Nagle; Kong Teng Tan; John Byrne

doi:10.1016/j.avsg.2018.09.012

Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair

Ann Vasc Surg. 2019 May:57:98-108. doi: 10.1016/j.avsg.2018.09.012. Epub 2018 Nov 28.

Authors

Ben Li¹, Janice Montbriand¹, Naomi Eisenberg¹, Graham Roche-Nagle², Kong Teng Tan³, John Byrne⁴

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
² Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
³ Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: john.byrne@uhn.ca.

PMID: 30500629
DOI: 10.1016/j.avsg.2018.09.012

Abstract

Background: The impact of aneurysm thrombus characteristics on type 2 endoleak rate following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is unclear. The purpose of this study is to determine the impact of pre-operative aneurysm thrombus volume and density on the incidence of type 2 endoleak following EVAR for infrarenal AAA.

Methods: A retrospective analysis was completed on all patients who underwent standard EVAR at an academic medical institution between May 1, 2010 and June 1, 2016 with a minimum follow-up period of 12 months. The final analysis included 170 patients. Thrombus volume and density were determined by analyzing pre-operative computed tomography angiography (CTA) scans using the TeraRecon plaque analysis module. The number and diameter of patent infrarenal aortic branch vessels were also identified. Type 2 endoleak was diagnosed by post-operative CTA, duplex ultrasound, or angiography.

Results: Over a median follow-up period of 29 months, 88 (51.8%) of 170 patients had a type 2 endoleak. The thrombus volume as a proportion of the infrarenal aorta volume was significantly lower in patients with type 2 endoleak (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.005-0.291, P = 0.002). The number of patent lumbar arteries was significantly greater in patients with type 2 endoleak (OR 1.45, 95% CI 1.16-1.56, P < 0.0005). Both variables independently predicted the incidence of type 2 endoleak in a multivariate analysis. Thrombus density was not related to the incidence of type 2 endoleak.

Conclusions: A lower ratio of thrombus volume/infrarenal aorta volume and a higher number of patent lumbar arteries were associated with an increased incidence of type 2 endoleak. A multivariate logistic regression model was generated to pre-operatively predict the risk of type 2 endoleak. This model can guide the stratification of patients for intensity of endoleak surveillance following EVAR and consideration of pre-operative treatment.

MeSH terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / surgery*
Aortography / methods
Blood Vessel Prosthesis Implantation / adverse effects*
Computed Tomography Angiography
Endoleak / diagnostic imaging
Endoleak / etiology*
Endovascular Procedures / adverse effects*
Female
Humans
Male
Retrospective Studies
Risk Assessment
Risk Factors
Thrombosis / diagnostic imaging
Thrombosis / surgery*
Time Factors
Treatment Outcome