Noninvasive diagnosis of incomplete endovascular aneurysm repair: D-dimer assay to detect type I endoleaks and nonshrinking aneurysms.
OBJECTIVE
To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair.


METHODS
In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak.


RESULTS
Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 +/- 180 ng/mL versus 421 +/- 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 +/- 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 +/- 728 ng/mL) than in cases with decreasing diameters (median 638 +/- 238 ng/mL) despite the presence of endoleak (p < 0.0005).


CONCLUSIONS
Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.
Serino
Francesco
F
Department of Vascular Surgery, IDI IRCCS, Rome, Italy. f.serino@idi.it
Abeni
Damiano
D
Galvagni
Elisabetta
E
Sardella
Savino G
SG
Scuro
Alberto
A
Ferrari
Mauro
M
Ciarafoni
Iole
I
Silvestri
Lorena
L
Fusco
Angelo
A
D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011336:Probability; D011475:Prosthesis Failure; D011863:Radioimmunoassay; D012016:Reference Values; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D