Outcomes of abdominal aortic aneurysm with aortic neck thrombus after endovascular abdominal aortic aneurysm repair

Abstract

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.