Escalation of Antithrombotic Therapy Should Be Considered in the Presence of Intraluminal Prosthetic Graft Thrombus Following Endovascular Aneurysm Repair

Russell, Terri-Ann; Premnath, Sivaram; Mogan, Meera; Langford, Grace; Paice, Bronte; Kirk, James; Rowlands, Timothy; Kuhan, Ganesh

doi:10.1016/j.ejvsvf.2022.03.003

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…In a multivariate logistic regression analysis, Russell et al . identified preexisting peripheral artery disease as a risk factor for ILT formation after endovascular aortic aneurysm repair ( 17 ). In their experience, escalation of antithrombotic therapy was associated with regression or prevention of progression of ILT in endovascular aortic grafts.…”

Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

“…Contrary to that, Russell et al . reported that 23% of patients with ILT after EVAR presented with symptoms of lower body claudication and 8% even required re-intervention for acute limb ischemia ( 17 ).…”

Section: Clinical Consequences Of Iltmentioning

confidence: 99%

Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

“…Although it is just now becoming apparent in FET prostheses, ILT formation in stented aortic grafts per se is not a new phenomenon and has been described for endovascular thoracic and abdominal aortic grafts even before the frozen elephant trunk technique was widely used (14)(15)(16)(17)(18)(19). Here, an incidence of ILT ranging from 10% to 36% is reported (16,17). ILT in endografts was frequently detected as a late complication during long-term follow-up with new thrombus formation occurring even after more than 24 months after implantation (16).…”

Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

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Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Helms,

Schmack,

Weymann

et al. 2024

Front. Cardiovasc. Med.

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Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation. Adverse thromboembolic events include acute occlusion of the celiac and superior mesenteric arteries, both renal arteries as well as acute lower limb ischemia due to iliac or femoral artery embolization that not infrequently require interventional or open embolectomy. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity. Currently proposed strategies to avoid ILT formation include a more aggressive anticoagulation management, minimization of postoperative coagulation factor application, and even technical optimizations of the stent graft portion itself. If ILT is manifested, the therapeutic strategies tested to date are long-term escalation of anticoagulation and early endovascular extension of the FET stent graft with overstenting of the intraluminal thrombus. The long-term efficiency of these prophylactic and therapeutic measures has yet to be proven. Nonetheless, all surgeons performing the frozen elephant trunk procedure must be aware of the risk of ILT formation to facilitate a timely diagnosis and therapy.

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Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

Section: Clinical Consequences Of Iltmentioning

confidence: 99%

Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

Section: Ilt In Endovascular Aortic Stent Graftsmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Helms,

Schmack,

Weymann

et al. 2024

Front. Cardiovasc. Med.

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show abstract

“…We read with interest the study published by Russell et al., which recommends antithrombotic therapy escalation whenever intraluminal prosthetic graft thrombus (IPT) is identified. 1 This recommendation was deduced from the finding that among 26 patients who developed IPT (10.1% of the reported 258 patients), six (23.1% of the IPT group) developed symptoms potentially attributable to IPT and two patients required re-interventions.…”

mentioning

confidence: 99%

Aim Before You Shoot: Within Graft Thrombus After EVAR is Generally Benign and Escalation of Antithrombotic Therapy is Not

Gonçalves

Oliveira

2022

EJVES Vascular Forum

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

Ulsaker¹,

Lam²,

Seternes³

et al. 2023

European Journal of Vascular and Endovascular Surgery

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Escalation of Antithrombotic Therapy Should Be Considered in the Presence of Intraluminal Prosthetic Graft Thrombus Following Endovascular Aneurysm Repair

Cited by 6 publications

References 24 publications

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Aim Before You Shoot: Within Graft Thrombus After EVAR is Generally Benign and Escalation of Antithrombotic Therapy is Not

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

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