The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2025-04-01 Epub Date: 2023-04-25 DOI:10.1177/15266028231170165
Masayuki Sugimoto, Tomohiro Sato, Shuta Ikeda, Yohei Kawai, Kiyoaki Niimi, Hiroshi Banno
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Abstract

Purpose: Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement.

Methods: A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. "Isolated" T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25-60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88-21.90] vs 7.62 [4.41-13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056-19.349]).

Conclusion: A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough.Clinical ImpactThe present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough.As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.

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持续性2型内漏患者EVAR后1年d -二聚体水平与囊直径变化的关系
目的:最近的研究表明,血栓的持续凝血更新在血管内动脉瘤修复(EVAR)后囊扩大中起核心作用。我们回顾了持续性2型内漏(T2EL)患者,以评估d -二聚体水平对囊增大的影响。方法:回顾性分析2007年6月至2020年2月期间对肾下腹主动脉瘤进行的选择性EVAR。持续性T2EL定义为在6个月和12个月的对比增强计算机断层扫描(CECT)随访中确诊的T2EL。“孤立型”T2EL定义为在12个月内没有其他类型的内漏。随访时间>2年、持续孤立t2l和1年d -二聚体水平数据(DD1Y)的患者纳入研究。排除12个月内再干预的患者。分析DD1Y与5年内动脉瘤增大(定义为直径增大≥5mm)之间的关系。761例常规EVAR患者中,515例随访时间>2年。33名患者在12个月内进行了任何再干预,127名患者在6个月或12个月未进行CECT。在131例持续性孤立型t2l患者中,纳入74例具有DD1Y数据的患者。在37个月的中位随访期间[25-60,IQR],共观察到24例ane。AnE患者的中位DD1Y明显高于其他患者(12.30 [6.88-21.90]vs 7.62 [4.41-13.00], P=0.024)。ROC曲线分析表明,DD1Y对AnE的最佳截断点为5.5µg/mL (AUC=0.681)。在单因素分析中,颈角、肠系膜下动脉闭塞、DD1Y≥5.5µg/mL与AnE显著相关(P= 0.037、0.038和0.010)。Cox回归分析显示,DD1Y≥5.5µg/mL与AnE相关(P=0.042, HR [95% CI] 4.520[1.056 ~ 19.349])。结论:1年较高的d -二聚体水平可以潜在地预测持续T2EL患者5年内的AnE。当d -二聚体水平足够低时,AnE被认为是不可能的。临床影响:目前的研究表明,1年较高的d -二聚体水平可以潜在地预测持续2型内漏(T2EL)患者5年内的动脉瘤扩张。另一方面,如果d -二聚体水平足够低,则认为动脉瘤不可能扩张。由于有许多T2EL患者需要定期随访,任何预测未来动脉瘤扩张的预测都可能对节约医疗资源有很大帮助。对于未来扩大可能性较低的患者,我们可以考虑延迟随访,类似于囊萎缩患者。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
期刊最新文献
Effects of Iliac Tortuosity Index on Fenestrated Endovascular Aortic Aneurysm Repair for Pararenal and Thoracoabdominal Aortic Aneurysms. Pulsatile Changes of the Aortic Diameter May Be Irrelevant Regarding Endograft Sizing in Patients With Aortic Disease. The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak. Sex-Related Outcomes in Asymptomatic Patients Undergoing Carotid Artery Stenting. Novel Surgeon-Modified Fenestrated Iliac Stent Graft.
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