Abstract
Purpose
To compare the inflammatory, coagulopathic, and fibrinolytic responses after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm between two stent grafts. Fibrinogen degradation product (FDP) levels were compared between patients with or without an endoleak.
Materials and methods
EVAR was performed in 88 patients using an Excluder (37 patients) or a Zenith (51 patients). White blood cell count (WBC), C-reactive protein (CRP) levels, platelet count, and FDP levels were measured before and after EVAR.
Results
WBC and CRP increased and the platelet count decreased significantly on days 1 and 3 after EVAR in the Zenith group compared with the Excluder group. The change in FDP from baseline to 7 days after EVAR was −1.99 ± 7.46 vs. 8.59 ± 9.38 μg/mL in patients with (n = 24) vs. without (n = 64) an endoleak (p < 0.001). A change in FDP of 3.1 μg/mL was the optimal cutoff point for predicting the presence of an endoleak (accuracy 0.762; sensitivity 0.875; specificity 0.717).
Conclusion
Inflammatory, coagulopathic, and fibrinolytic responses were greater in the Zenith group than in the Excluder group. A change in FDP of ≤3.1 μg/mL was predictive of an endoleak after EVAR.
Similar content being viewed by others
References
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–9.
Matsumura JS, Brewster DC, Makaroun MS, Naftel DC. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg. 2003;37:262–71.
Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial I), 30-day operative mortality results: randomized controlled trial. Lancet. 2004;364:843–8.
Brewster DC, Jones JE, Chung TK, Lamuraglia GM, Kwolek CJ, Watkins MT, et al. Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade. Ann Surg. 2006;244:426–38.
Greenberg RK, Chuter TA, Sternbergh WC III, Fearnot NE, Zenith Investigators. Zenith AAA endovascular graft: intermediate-term results of the US multicenter trial. J Vasc Surg. 2006;244:426–38.
Nakai M, Sato M, Sato H, Sakaguchi H, Tanaka F, Ikoma A, et al. Midterm results of endovascular abdominal aortic aneurysm repair: comparison of instruction-for-use (IFU) cases and non-IFU cases. Jpn J Radiol. 2013;31:585–92.
Karthikesalingam A, Jackson D, AI-Jundi W, Jackson D, Boyle JR, Beard JD, et al. Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair. Br J Surg. 2012;99:1514–23.
Stavropoulos SW, Itkin M, Lakhani P, Carpenter JP, Fairman RM, Alavi A. Detection of endoleaks after endovascular aneurysm repair with use of technetium-99 m sulfur colloid and (99 m)Tc-labeled red blood cell scans. J Vasc Interv Radiol. 2006;17:1739–43.
Kilicarslan A, Uysal A, Roach EC. Acute phase reactants. Acta Medica. 2013;2:2–7.
Fisher DF, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysm: a prospective study of 76 cases. Arch Surg. 1983;118:1252–5.
Englberger L, Savolainen H, Jandus P, Widmer M, do Do D, Haeberli A, et al. Activated coagulation during open and endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2006;43:1124–9.
Aho PS, Niemi T, Piilonen A, Lassila R, Renkonen R, Lepäntalo M. Interplay between coagulation and inflammation in open and endovascular abdominal aortic aneurysm repair—impact of intra-aneurysmal thrombus. Scand J Surg. 2007;96:229–35.
Davies RS, Abdelhamid M, Wall ML, Vohra RK, Bradbury AW, Adam DJ. Coagulation, fibrinolysis, and platelet activation in patients undergoing open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2011;54:865–78.
Monaco M, Di Tommaso L, Stassano P, Smimmo R, De Amicis V, Pantaleo A, et al. Impact of blood coagulation and fibrinolytic system changes on early and mid term clinical outcome in patients undergoing stent endografting surgery. Interact Cardiovasc Thorac Surg. 2006;5:724–9.
Abdelhamid MF, Davies RS, Adam DJ, Vohra RK, Bradbury AW. Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2012;55:41–6.
Ishii S, Sato M, Sonomura T, Yamada K, Tanihata H, Ishikawa H, et al. Optimal covering material for stent-grafts placed in the portal vein in a canine model. Cardiovasc Intervent Radiol. 2005;28:624–31.
Hogg ME, Morasch MD, Park T, Flannery WD, Makaroun MS, Cho JS. Long-term sac behavior after endovascular abdominal aortic aneurysm repair with the Excluder low-permeability endoprosthesis. J Vasc Surg. 2011;5:1178–83.
Swartbol P, Truedsson L, Norgren L. Adverse reactions during endovascular treatment of aortic aneurysms may be triggered by interleukin 6 release from the thrombotic content. J Vasc Surg. 1998;28:664–8.
Moulakakis KG, Alepaki M, Sfyroeras GS, Antonopoulos CN, Giannakopoulos TG, Kakisis J, et al. The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm. J Vasc Surg. 2013;57:668–77.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ikoma, A., Nakai, M., Sato, M. et al. Changes in inflammatory, coagulopathic, and fibrinolytic responses after endovascular repair of an abdominal aortic aneurysm: relationship between fibrinogen degradation product levels and endoleaks. Jpn J Radiol 32, 347–355 (2014). https://doi.org/10.1007/s11604-014-0314-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-014-0314-0