Evaluation of thrombogenicity by indium-111 platelet scintigraphy in endografting for abdominal aortic aneurysms.
Obstruction of the endograft limb by thrombosis has often been reported and may cause fatal complications such as leg necrosis or myonephropathic metabolic syndrome. The purpose of this study was to evaluate endograft antithrombogenicity by indium-111 platelet scintigraphy. Seventeen patients with abdominal aortic aneurysms were treated by endografting. Thirteen patients were treated with conventional open surgery using an artificial graft. The endograft was constructed from a self-expanding Z-shaped stent and woven polyester fabric. Autologous platelets labeled with indium-111 were injected at 2 weeks postoperatively. At 24 hours and 72 hours postinjection, the ratio of scintillation count of the endograft or graft to that of the native artery was calculated to assess platelet deposition. The normalization ratio was calculated as follows: (scintillation count per pixel of endograft or graft/circumference)/(scintillation count per pixel of the native femoral artery). Platelet factor 4 and beta-thromboglobulin were measured to evaluate the systemic platelets activity at 2 weeks postoperatively. There was no significant difference in platelet counts or labeling efficiency between the groups. The ratio was significantly higher in the endografting group than in the open surgery group at 72 hours postinjection (2.5-0.7 vs 3.9-1.1, P<.001). There was no significant difference in platelet factor 4 and beta-thromboglobulin between the groups. Although there was no difference in systemic platelet activity, endografting was associated with lower antithrombogenicity. It remains unclear whether lower antithrombogenicity causes thromboembolism as a complication of the procedure. The authors recommend the administration of antiplatelet drugs to prevent endograft obstruction in patients with very narrow iliac arteries.
Shimazaki
Taro
T
Department of Surgery II, Tokyo Medical University, Tokyo, Japan. taro-shi@pa2.so-net.ne.jp
Kawaguchi
Satoshi
S
Yokoi
Yoshihiko
Y
Makimura
Susumu
S
Saiki
Naozumi
N
Watanabe
Yoshiko
Y
Ishimaru
Shin
S
D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000473:pathology / Q000601:surgery*; D001792:Blood Platelets / Q000000981:diagnostic imaging*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D007205:Indium Radioisotopes; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000378:metabolism; D017713:Platelet Transfusion; D011474:Prosthesis Design; D011877:Radionuclide Imaging; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D001620:beta-Thromboglobulin / Q000378:metabolism
D007205:Indium Radioisotopes; D010975:Platelet Aggregation Inhibitors; D001620:beta-Thromboglobulin; D010978:Platelet Factor 4