title: Preoperative Intrasac Thrombus Load Predicts Worse Outcome after Elective Endovascular Repair of Abdominal Aortic Aneurysms.
abstract: OBJECTIVE
  To evaluate the impact of two-dimensional and three-dimensional preoperative morphologic features analyzed on computed tomography (CT) angiography on midterm outcome in patients with abdominal aortic aneurysms (AAAs) treated with endovascular aneurysm repair (EVAR).
  
  
  METHODS
  A retrospective analysis was conducted using a prospectively collected database. Morphologic features considered as potentially influencing outcomes were maximum aortic diameter, thrombus area, overall aneurysm volume, and intrasac thrombus volume. Outcome measures were all perioperative and midterm AAA-related reinterventions and all-cause mortality.
  
  
  RESULTS
  Investigators reviewed 191 preoperative CT angiography scans. Mean maximum aortic diameter was 58 mm; thrombus area, 49.6%; aortic volume, 159.36 cm(3); and thrombus volume, 58.6%. Technical success was achieved in all cases. No reintervention was required in the perioperative period, and there was no perioperative mortality. At a mean follow-up of 32 months ± 16.8 (range, 3-66 mo), mortality rate was 9.4%, AAA-related death was 0, and reintervention rate was 8.9%. Causes of reintervention included type I endoleak (n = 3 [1.6%]), type II endoleak (n = 7 [3.7%]), type III endoleak (n = 1 [0.5%]), endograft limb thrombosis (n = 4 [2.1%]), and access vessel thrombosis (n = 2; 1%). Greater thrombus area (> 60%) and thrombus volume (> 59%) were predictors for reintervention (P = .005 and P = .0034). Greater maximum aortic diameter (> 59 mm) and aortic volume (> 159 cm(3)) were related to higher reintervention rate without statistical significance (P = .62 and P = .12). Aortic volume was a predictor of any adverse event, reintervention, and all-cause mortality after EVAR (P = .03).
  
  
  CONCLUSIONS
  Thrombus area and volume are related to higher rates of reintervention. Maximum aortic diameter was related to a higher reintervention rate, but this was not significant.
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy. Electronic address: sirignanop@alice.it.
authors: Pasqualino
authors: P
authors: Sirignano
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Danilo
authors: D
authors: Menna
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Laura
authors: L
authors: Capoccia
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Nunzio
authors: N
authors: Montelione
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Wassim
authors: W
authors: Mansour
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Anna Rita
authors: AR
authors: Rizzo
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Enrico
authors: E
authors: Sbarigia
authors: Vascular and Endovascular Surgery Division, Department of Surgery Paride Stefanini, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy.
authors: Francesco
authors: F
authors: Speziale
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D015897:Comorbidity; D057510:Endovascular Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011300:Preoperative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D015996:Survival Rate; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome