A Retrospective Evaluation of Intra-Prosthetic Thrombus Formation After Endovascular Aortic Repair in Cook Zenith Alpha and Medtronic Endurant II Patients

Eur J Vasc Endovasc Surg. 2023 Nov;66(5):644-651. doi: 10.1016/j.ejvs.2023.05.043. Epub 2023 Jun 5.

Abstract

Objective: To investigate the occurrence of limb graft occlusion (LGO) and intra-prosthetic thrombus (IPT) formation in Zenith Alpha and Endurant II stent graft limbs.

Methods: A single centre retrospective study was conducted on patients treated with the Zenith Alpha and Endurant II stent grafts between 2017 and 2019. All post-operative computed tomography angiography images were re-investigated for thrombus formation. Demographic, aneurysm, and stent graft data were collected and compared. LGO was defined as complete occlusion or significant stenosis (≥ 50% lumen diameter reduction). Logistic regression on pro-thrombotic risk factors was conducted. Freedom from LGO and overall limb IPT were compared using Kaplan-Meier analyses.

Results: Seventy-eight Zenith Alpha and eighty-six Endurant II patients were studied. The median follow up was 33 (IQR 25, 44) months for Zenith Alpha patients and 36 (IQR 22, 46) months for Endurant II patients (p = .53). LGO was seen in 15% (n = 12) of Zenith Alpha patients and 5% (n = 4) of Endurant II patients (p = .032), and freedom from LGO was significantly higher among Endurant II patients (p = .024). The Zenith Alpha stent graft was an independent risk factor for LGO (OR 3.9, 95% CI 1.1 - 13.4; p = .032). Among Zenith Alpha patients, limb flare compression within the main body gate was over represented in LGO patients (p = .011). There was no difference in freedom from overall limb IPT between the stent graft systems. For Endurant II limbs, IPT was significantly less common in the integrated ipsilateral limbs (without ETLW/ETEW stent graft limbs) (p = .044). Main endograft body IPT was correlated with overall limb IPT (p = .035).

Conclusion: LGO was significantly more common among Zenith Alpha than Endurant II patients. Zenith Alpha limbs was an independent risk factor for LGO. There was no difference between stent grafts in overall limb IPT formation.

Keywords: Abdominal aortic aneurysm; Endovascular aortic repair; Graft thrombosis; Limb occlusion.

Publication types

  • Comment

MeSH terms

  • Aortic Aneurysm, Abdominal* / complications
  • Aortic Aneurysm, Abdominal* / diagnostic imaging
  • Aortic Aneurysm, Abdominal* / surgery
  • Blood Vessel Prosthesis / adverse effects
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / methods
  • Endovascular Aneurysm Repair
  • Endovascular Procedures* / adverse effects
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / epidemiology
  • Graft Occlusion, Vascular / etiology
  • Humans
  • Prosthesis Design
  • Retrospective Studies
  • Risk Factors
  • Stents / adverse effects
  • Thrombosis* / complications
  • Thrombosis* / etiology
  • Treatment Outcome