Academic Journal
Impact of Infrarenal Neck Thrombus in Endovascular Aortic Aneurysm Repair on Proximal Seal and Type Ia Endoleak.
| Τίτλος: | Impact of Infrarenal Neck Thrombus in Endovascular Aortic Aneurysm Repair on Proximal Seal and Type Ia Endoleak. |
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| Συγγραφείς: | Hendricks CHF; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address: c.h.f.hendricks@umcg.nl., Schuurmann RCL; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands., Fioole B; Division of Vascular Surgery, Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands., Bokkers RPH; Division of Interventional Radiology, Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands., van Dam L; Division of Interventional Radiology, Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands., van Veldhuizen WA; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands., Kropman RHJ; Division of Vascular Surgery, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands., Vos JA; Division of Interventional Radiology, Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands., de Vries JPM; Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands. |
| Πηγή: | European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2026 Sep; Vol. 72 (3), pp. 428-435. Date of Electronic Publication: 2025 Dec 12. |
| Τύπος έκδοσης: | Journal Article; Multicenter Study; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: England NLM ID: 9512728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2165 (Electronic) Linking ISSN: 10785884 NLM ISO Abbreviation: Eur J Vasc Endovasc Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2002-: London : Elsevier Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995- |
| Ιατρικοί όροι (MeSH): | Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/complications , Aortic Aneurysm, Abdominal*/diagnostic imaging , Blood Vessel Prosthesis Implantation*/adverse effects , Endoleak*/etiology , Endoleak*/epidemiology , Endovascular Aneurysm Repair*/adverse effects , Endovascular Aneurysm Repair*/instrumentation , Endovascular Aneurysm Repair*/methods , Thrombosis*/diagnostic imaging , Thrombosis*/complications , Thrombosis*/surgery, Aortography/methods ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Blood Vessel Prosthesis ; Computed Tomography Angiography ; Netherlands ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome |
| Περίληψη: | Objective: Endograft instructions for use often list infrarenal aortic neck thrombus as a contraindication to endovascular aortic repair (EVAR), yet supporting evidence is limited. This study assessed the impact of neck thrombus on proximal seal and its association with type Ia endoleak and secondary intervention. Methods: A multicentre, retrospective, observational cohort study of consecutive patients who underwent elective EVAR for degenerative infrarenal abdominal aortic aneurysm was performed at three high volume hospitals in the Netherlands. Aortic morphology and endograft outcomes were analysed. Patients with infrarenal neck thrombus (≥ 2 mm thick and ≥ 25% circumference) were compared with those without. Shortest apposition length (SAL) was measured on post-operative computed tomography angiography. In the thrombus group, SAL was measured both including (SALTh) and excluding (SAL) stent apposition to the thrombus. Thrombus volume was measured before and after surgery. Kaplan-Meier analysis determined type Ia endoleak free and secondary intervention free survival. Results: Among 310 patients (median follow up 4.28 years; interquartile range 1.37, 5.91 years), 91 (29.4%) had neck thrombus. Baseline characteristics were similar. On the first post-operative computed tomography angiogram, the thrombus group had a lower median SAL (17.6 mm vs. 23.0 mm, p < .001), but SALTh was comparable with the SAL in the no thrombus group (24.1 mm vs. 23.0 mm, p = .93). At five years, type Ia endoleak free survival was 92.6% in the thrombus group vs. 95.4% in the no thrombus group (p = .24). Secondary intervention free survival was 83.6% vs. 80.9% (p = .39). SAL increased over time in both groups, whereas thrombus volume decreased or resolved in all patients with thrombus. Conclusion: As neck thrombus volume diminishes over time, the proximal seal length increases, similar to that in patients without neck thrombus. In this midterm analysis, no statistically significant differences in type Ia endoleak free survival and secondary intervention free survival were observed between the thrombus and no thrombus groups. EVAR may not be contraindicated in patients with neck thrombus. (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.) |
| Contributed Indexing: | Keywords: Abdominal aortic aneurysm; Endoleak; Endovascular aneurysm repair; Neck thrombus; Seal; Shortest apposition length |
| Entry Date(s): | Date Created: 20251214 Date Completed: 20260908 Latest Revision: 20260921 |
| Update Code: | 20260922 |
| DOI: | 10.1016/j.ejvs.2025.12.019 |
| PMID: | 41391558 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1532-2165 |
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| DOI: | 10.1016/j.ejvs.2025.12.019 |