Rationale: Persistent endoleaks(EL) due to inadequate stent attachment or fixation, have been generally considered a treatment failure, thus a primary endpoint in long term follow ups, even if most recently the axiom EL-increased AAA volume-rupture has been criticized. Since it has been shown that even patients with a negative early follow up are not exempt from risks for late endoleak formation or rupture , a warning has been raised in that all patients treated with endovascular devices should be carefully followed lifetime. Therefore , non invasive and non expensive tools for detection of an imperfect endograft functioning are needed.Thesis: in presence of a demonstrable peri graft flow and generally in case of an increasing sac volume, active intravascular thrombus formation occurs and specific markers for endogenous fibrinolysis could detect them and alert for further investigation. D –Dimer (D-D) is a plasmin resistant fibrin fragment which , in the diagnosis of intra vascular thrombosis, has shown high specificity ,sensitivity and high negative predictive value. Methods: We analyzed the D -D blood level in 83 patients selected by the following carachteristics:1. affected by AAA, 2.evaluated and treated with endovascular exclusion with AneuRx Endograft, in follow up after an implant with 3. no endoleak and decreasing volume, 4. with type I endolaeks, 5. Type 2 endoleaks, with 6. Invariated or increased or 7. decreased sac maximal diameter.Plasma was drown in correspondence of the TC scan and clinical monitoring relative to which information on AAA where drown. Plasma was frozen and analyzed for D-D through a Latex quantitative test. Results were stratified according to the patient’s clinical stage. Results: D-D values presented a high interpersonal variability with generally width standard deviations. D –D values do not significantly varied among patients with stable AAA and age matched controls ( 238±245 vg/ml vs 421± 400vg/ml, p> 0.05) . D- D values increase significantly (727± 345 vg/ml vs 421±400 vg/ml p<0.05) immediately after treatment (4th p.o. day). Values do not significantly vary at various distance from the procedure if there is no EL and AAA volume decrease or if Type 2 EL were present. D-D values significantly increased (1931± 924 vg/ml, p< 0.005 vs all other groups) in case of Type 1 EL and in case of EL with unmodified or increasing AAA diameters in comparison with EL and decreasing diameters (1177± 773 vg/ml vs 778±466 vg/ml, p< 0.005).Conclusion: elevated D-D may prove to be a useful arker for fixation problems after endovascular repair and may help rule out of type I endoleak, thus excluding patients from unnecessary invasive tests.
Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimero assay to detect type I Endoleaks and nonshrinking aneurisms
GALVAGNI, Elisabetta;SCURO, Alberto;
2002-01-01
Abstract
Rationale: Persistent endoleaks(EL) due to inadequate stent attachment or fixation, have been generally considered a treatment failure, thus a primary endpoint in long term follow ups, even if most recently the axiom EL-increased AAA volume-rupture has been criticized. Since it has been shown that even patients with a negative early follow up are not exempt from risks for late endoleak formation or rupture , a warning has been raised in that all patients treated with endovascular devices should be carefully followed lifetime. Therefore , non invasive and non expensive tools for detection of an imperfect endograft functioning are needed.Thesis: in presence of a demonstrable peri graft flow and generally in case of an increasing sac volume, active intravascular thrombus formation occurs and specific markers for endogenous fibrinolysis could detect them and alert for further investigation. D –Dimer (D-D) is a plasmin resistant fibrin fragment which , in the diagnosis of intra vascular thrombosis, has shown high specificity ,sensitivity and high negative predictive value. Methods: We analyzed the D -D blood level in 83 patients selected by the following carachteristics:1. affected by AAA, 2.evaluated and treated with endovascular exclusion with AneuRx Endograft, in follow up after an implant with 3. no endoleak and decreasing volume, 4. with type I endolaeks, 5. Type 2 endoleaks, with 6. Invariated or increased or 7. decreased sac maximal diameter.Plasma was drown in correspondence of the TC scan and clinical monitoring relative to which information on AAA where drown. Plasma was frozen and analyzed for D-D through a Latex quantitative test. Results were stratified according to the patient’s clinical stage. Results: D-D values presented a high interpersonal variability with generally width standard deviations. D –D values do not significantly varied among patients with stable AAA and age matched controls ( 238±245 vg/ml vs 421± 400vg/ml, p> 0.05) . D- D values increase significantly (727± 345 vg/ml vs 421±400 vg/ml p<0.05) immediately after treatment (4th p.o. day). Values do not significantly vary at various distance from the procedure if there is no EL and AAA volume decrease or if Type 2 EL were present. D-D values significantly increased (1931± 924 vg/ml, p< 0.005 vs all other groups) in case of Type 1 EL and in case of EL with unmodified or increasing AAA diameters in comparison with EL and decreasing diameters (1177± 773 vg/ml vs 778±466 vg/ml, p< 0.005).Conclusion: elevated D-D may prove to be a useful arker for fixation problems after endovascular repair and may help rule out of type I endoleak, thus excluding patients from unnecessary invasive tests.File | Dimensione | Formato | |
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