¿Es la carga de trombo y su localización en el saco un factor protector de endofugas tipo II ?

Background: Type II endoleaks (ELII) may increase the complication rate. An evaluation was made of the association between thrombus load and development of ELII, and aneurysm sac growth.Material and methodmethods: A total of 103 endovascular aortic repair patients were analyzed. The maximum thrombus thickness (GMT), percentages of area (PAOT) and perimeter lined by thrombus (PPCT), and posterior thickness (GMHP) were determined from pre-operative CT at 3 levels: zone A (maximum diameter), zone B (from zone A to bifurcation), and zone C( from neck to zone A). The number of aortic side branches was recorded, and sac diameter was measured during follow-up.Results: A total of 51 endoleaks (49.5%) were noted. Patients with ELII had significantly less GMT( 24.0 vs. 18.6 mm, P=.01) and GMHP (13.9 vs. 18.9 mm, P=.003) in zone A, and PAOT (49.7 vs. 65.4%, P<.001), PPCT (72.4 vs. 82.3%, P<.001), and PTHP (63.7 vs. 74.7%, P=.03). The average number of side branches was 5 in patients without ELII versus 6 with (P=.004). Lower risk ofELII was observed with: PAOT (OR = 0.65 for a 10% increase, 0.44-0.98, P=.03), PPCT in zone B( OR = 0.69 for each 10% increase, 0.50-0.95, P=.01), and C (OR = 0.68, 0.52-0.88, P=.002), GMHP in zone A (OR = 0.71 for each 5 mm increase, 0.49-0.99, P=.04), and PTHP in zone B (OR = 0.81 for 10% increase, 0.67-0.99, P=.02). The patent IMA (OR = 3.1, 1.1-8.9, P=.033), the number of patent branches (OR = 4.6 with more than 4 branches, 1.8-12.2, P=0.024), and lumbar branches( OR = 1.9 for each patent lumbar, 1.1-3.5, P=.017) were associated with an increased risk of ELII. The greater PAOT, PPCT, GMHP, and PTHP were, the higher regression/stability of the sac was.Conclusions: Quantification of the thrombus load and the number of patent side branches can be used to determine patients at increased risk of ELII and sac growth during follow-up. (C) 2014 SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.