Thrombus Load May Predict Worse Outcome after EVAR
The above article is noteworthy as it challenges a commonly held assumption regarding sac thrombus and re-intervention rates. While previous work (2, 3) has suggested that thrombus load is actually protective of future interventions (namely type II endoleak), the current manuscript has shown that this assumption may not be valid. However, the current study has a smaller sample size and a lower rate of re-intervention (8.9% vs 15.4%) when compared with prior work. Further, earlier research focused more on presence or absence of endoleak rather than growth or shrinkage of sac size. Additionally, given changes in device design, one may argue how comparable two sample cohorts from >10yrs apart are. Lastly, given the large number of variables present (neck angulation, neck length, presence or absence of patent vessels within the sac, etc.) it may be difficult to tease out meaningful conclusions from a small data set. Regardless, if nothing else, the questions raised in the manuscript point to the continued need for research in this challenging patient population.
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1. Sirignano, et al. Preoperative intrasac thrombus load predicts worse outcome after elective endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2015; 26:1431-6.
2. Rai D, Wisniowski B, Bradshaw B, et al. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair. Eur Radiol 2014; 24:1768–1776. 28.
3. Sampaio SM, Panneton JM, Mozes GI, et al. Aneurysm sac thrombus load predicts type II endoleaks after endovascular aneurysm repair. Ann Vasc Surg 2005; 19:302–309.
Luke R. Wilkins, MD