Post-EVAR Thrombus Density on Late Non-Contrast CT Scans Predicts Successful Aneurysm Exclusion

Vasc Endovascular Surg. 2021 Apr;55(3):239-244. doi: 10.1177/1538574420980621. Epub 2020 Dec 21.

Abstract

Purpose: The incidence of type II endoleaks (ELII) after endovascular aneurysm repair (EVAR) ranges from 10-44%. Aneurysm thrombus density after EVAR could predict successful aneurysm exclusion.

Materials and methods: Twenty-seven patients with an abdominal aortic aneurysm (AAA) who had a CT scan within the first 45 days (early group) post-surgery or after 7 months (late group) were included. Thrombus density was analyzed on non-contrast enhanced CT scans.

Results: A total of 5/13 (38%) patients in the early group had an ELII and 9/14 (64.3%) in the late group had a persistent ELII since surgery. In the early group, thrombus density was similar in patients with or without an ELII (mean: 39.9 ± 4.8 vs. 41.9 ± 3.4, p = 0.7; median: 38.7 ± 4.8 vs. 39.7 ± 3.1, p = 0.8). In patients with an ELII, there was no difference in thrombus density at 45 days and after 7 months (mean: 39.9 ± 4.8 vs. 40.2 ± 2.1, p = 0.9; median: 38.7 ± 4.8 vs. 38 ± 2.6, p = 0.9). In patients without an ELII, thrombus density was significantly higher at 45 days than after 7 months (mean: 41.9 ± 3.44 vs. 25.7 ± 2.0, p = 0.005; median: 39.7 ± 3.11 vs. 24.4 ± 1.5, p = 0.004). In patients with an ELII, thrombus density was significantly higher after 7 months than in patients without an ELII (mean: 40.2 ± 2.1 vs. 25.7 ± 2.0. p = 0.001; median: 38 ± 2.6 vs. 24.4 ± 1.5, p = 0.003).

Conclusion: Low thrombus density after EVAR on late unenhanced CT scans predicts aneurysm exclusion.

Keywords: abdominal aortic aneurysm; computed tomography; endoleak type II; endovascular aortic aneurysm repair; thrombus density.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / physiopathology
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography*
  • Computed Tomography Angiography*
  • Endoleak / diagnostic imaging*
  • Endoleak / etiology
  • Endoleak / physiopathology
  • Endovascular Procedures* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Thrombosis / diagnostic imaging*
  • Thrombosis / physiopathology
  • Time Factors
  • Treatment Outcome