Outcomes of Abdominal Aortic Aneurysm with
Aortic Neck Thrombus after Endovascular
Abdominal Aortic Aneurysm Repair
Khamin Chinsakchai MD*,
Kiattisak Hongku MD*, Suteekhanit Hahtapornsawan MD*, Chumpol Wongwanit MD*,
Chanean Ruangsetakit MD*, Nuttawut Sermsathanasawadi MD, PhD*, Pramook Mutirangura MD*
Affiliation :
* Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Endovascular abdominal aortic aneurysm repair (EVAR) has increasingly been performed for the last two
decades. One of the anatomical exclusion criterion of EVAR is the presence of thrombus within the infrarenal neck of an
aneurysm.
Objective : To investigate the influence of proximal aortic neck thrombus morphology on clinical outcomes after EVAR.
Material and Method: The subjects were retrospectively recruited from all the patients whom undergone EVAR in our
institution between January 2010 and December 2012. The patients with apparent thrombus of more than 40% at proximal
aortic neck were included. Primary endpoints consisted of technical success and perioperative mortality. Secondary endpoints
included adjuvant procedures at neck, procedural details, perioperative adverse events, ICU, and hospital stay. The late
outcomes of stent grafts related complications were the presence of endoleak, aneurysm expansion, stent graft migration,
stent graft thrombosis, AAA rupture, secondary intervention rate, and conversion to open repair.
Results : Twenty-one out of 145 patients having thrombus of more than 40% of circumferential aortic neck underwent EVAR.
The mean follow-up was 15.4 months (range, 2-36 months). There was 100% technical success with no perioperative death.
Adjuvant of aortic neck procedure was required in three patients. One patient developed graft limb occlusion. In addition,
one patient developed renal infarction requiring long-term hemodialysis and two patients presented with blue toe syndrome
and trash feet. During late follow-up, three, five, and two patients had a type II endoleak at one, six, and 12 months, respectively
without AAA sac expansion. There was no stent graft migration, stent graft thrombosis, or ruptured AAA. Three patients
expired during the late follow-up. In addition, there was neither conversion to opened repair nor secondary intervention.
Conclusion : The presence of aortic neck thrombus may not be a contraindication for EVAR in selected patients. However,
it seems to negatively influence the outcomes in the aspect of renal and peripheral embolization, which could be prevented
during EVAR procedure. There was no adverse graft-related complication, secondary intervention, or aneurysm-related
mortality during mid-term follow-up period.
Keywords : Abdominal aortic aneurysm, Aortic neck thrombus, Outcome
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