Academic Journal
Preoperative D-dimer and Intraluminal Thrombus Ratio Appear to Interact in Predicting Aneurysm Expansion After Endovascular Repair in Patients With Persistent Type 2 Endoleak.
| Τίτλος: | Preoperative D-dimer and Intraluminal Thrombus Ratio Appear to Interact in Predicting Aneurysm Expansion After Endovascular Repair in Patients With Persistent Type 2 Endoleak. |
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| Συγγραφείς: | Sugimoto M; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan. msugi@med.nagoya-u.ac.jp., Fujii T; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan., Osawa T; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan., Lee C; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan., Ikeda S; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan., Akita N; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan., Banno H; Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya, 466-8550, Japan. |
| Πηγή: | Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2026 Aug; Vol. 49 (8), pp. 1469-1478. Date of Electronic Publication: 2026 Jun 19. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003538 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-086X (Electronic) Linking ISSN: 01741551 NLM ISO Abbreviation: Cardiovasc Intervent Radiol Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York Ny : Springer Verlag Original Publication: [Berlin, New York] Springer International. |
| Ιατρικοί όροι (MeSH): | Fibrin Fibrinogen Degradation Products*/metabolism , Fibrin Fibrinogen Degradation Products*/analysis , Endoleak*/blood , Endoleak*/diagnostic imaging , Thrombosis*/blood , Thrombosis*/diagnostic imaging , Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/blood , Aortic Aneurysm, Abdominal*/diagnostic imaging , Endovascular Aneurysm Repair*, Biomarkers/blood ; Humans ; Female ; Retrospective Studies ; Male ; Aged ; Middle Aged ; Predictive Value of Tests ; Aged, 80 and over |
| Περίληψη: | Purpose: To determine whether preoperative D-dimer and intraluminal thrombus ratio interact to predict aneurysm expansion in patients with persistent type 2 endoleak after endovascular aneurysm repair, informing candidate selection for prophylactic embolization. Materials and Methods: This retrospective single-center study analyzed 138 patients with persistent type 2 endoleak confirmed at 12-month follow-up after elective infrarenal endovascular aneurysm repair (2007-2020). The primary outcome was aneurysm expansion ≥ 10 mm within 5 years, assessed by Cox models with a D-dimer × intraluminal thrombus ratio interaction term and generalized estimating equations for continuous diameter change. Patients were stratified by median D-dimer (4.1 μg/mL) and median intraluminal thrombus ratio (41.5%). Results: During median follow-up of 4.7 years, 27 patients (19.6%) developed the primary outcome. High D-dimer predicted expansion overall (hazard ratio 3.37; 95% confidence interval 1.39-8.21; P = 0.007). Within the high intraluminal thrombus ratio stratum, high D-dimer conferred markedly elevated risk (hazard ratio 13.06; 95% confidence interval 1.69-101.24; P = 0.014; Firth's regression: hazard ratio 8.29; P = 0.015); D-dimer was not predictive in the low intraluminal thrombus ratio stratum (P = 0.46). The three-way generalized estimating equations interaction was significant (P = 0.015); annual diameter change diverged markedly (+ 2.18 vs. + 0.04 mm/year), with a 12.6-mm difference at 60 months (P = 0.003). Conclusion: Preoperative D-dimer and intraluminal thrombus ratio interact to predict midterm aneurysm expansion. In patients with high thrombus burden, D-dimer identifies a high-risk subgroup and a low-risk subgroup amenable to standard surveillance. Level of Evidence: Level 3b, Retrospective cohort study. (© 2026. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).) |
| Competing Interests: | Declarations. Consent for Publication: For this type of study consent for publication is not required. Declaration of Generative AI and AI-Assisted Technologies: During the preparation of this work the authors used DeepL Write and Claude Sonnet 4.5 (Anthropic) in order to improve the English. After using these services, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article. Ethical Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Nagoya University (2019-0096 15835). Informed Consent: Written informed consent was obtained from all participants. |
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| Contributed Indexing: | Keywords: D-dimer; EVAR; Intraluminal thrombus; Type 2 endoleak |
| Substance Nomenclature: | 0 (Fibrin Fibrinogen Degradation Products) 0 (fibrin fragment D) 0 (Biomarkers) |
| Entry Date(s): | Date Created: 20260619 Date Completed: 20260802 Latest Revision: 20260802 |
| Update Code: | 20260803 |
| DOI: | 10.1007/s00270-026-04506-3 |
| PMID: | 42321568 |
| Βάση Δεδομένων: | MEDLINE |
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