Walter Tim, Berger Tim, Kondov Stoyan, Gottardi Roman, Benk Julia, Rylski Bartosz, Czerny Martin, Kreibich Maximilian
Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany.
Front Cardiovasc Med. 2022 Jun 30;9:921479. doi: 10.3389/fcvm.2022.921479. eCollection 2022.
Our aim was to investigate the occurrence and clinical consequence of postoperative in-stent thrombus formation following the frozen elephant trunk (FET) procedure.
Postoperative computed tomography angiography (CTA) scans of all 304 patients following the FET procedure between 04/2014 and 11/2021 were analysed retrospectively. Thrombus size and location were assessed in multiplanar reconstruction using IMPAX EE (Agfa HealthCare N.V., Morstel, Belgium) software. Patients' characteristics and clinical outcomes were evaluated between patients with and without thrombus formation.
During the study period, we detected a new postoperative in-stent thrombus in 19 patients (6%). These patients were significantly older ( = 0.009), predominantly female ( = 0.002) and were more commonly treated for aortic aneurysms ( = 0.001). In 15 patients (79%), the thrombi were located in the distal half of the FET stent-graft. Thrombus size was 18.9 mm (first quartile: 12.1; third quartile: 33.2). Distal embolisation occurred in 4 patients (21%) causing one in-hospital death caused by severe visceral ischaemia. Therapeutic anticoagulation was initiated in all patients. Overstenting with a conventional stent-graft placed within the FET stent-graft was the treatment in 2 patients (11%). Outcomes were comparable both groups. Female sex ( = 0.005; OR: 4.289) and an aortic aneurysm ( = 0.023; OR: 5.198) were identified as significant predictors for thrombus development.
Postoperative new thrombus formation within the FET stent-graft is a new, rare, but clinically highly relevant event. The embolisation of these thrombi can result in dismal postoperative outcomes. More research is therefore required to better identify patients at risk and improve perioperative treatment.
我们的目的是研究采用冰冻象鼻术（FET）后的支架内血栓形成的发生率及临床后果。
回顾性分析2014年4月至2021年11月期间接受FET手术的304例患者的术后计算机断层血管造影（CTA）扫描结果。使用IMPAX EE（爱克发医疗保健公司，比利时莫斯特尔）软件在多平面重建中评估血栓大小和位置。对有血栓形成和无血栓形成的患者的特征及临床结局进行评估。
在研究期间，我们在19例患者（6%）中检测到新的术后支架内血栓。这些患者年龄显著更大（P = 0.009），女性居多（P = 0.002），且更常见于接受主动脉瘤治疗的患者（P = 0.001）。在15例患者（79%）中，血栓位于FET支架移植物的远端一半。血栓大小为18.9毫米（第一四分位数：12.1；第三四分位数：33.2）。4例患者（21%）发生远端栓塞，导致1例因严重内脏缺血死亡。所有患者均开始进行治疗性抗凝。2例患者（11%）采用在FET支架移植物内放置传统支架移植物进行覆盖支架治疗。两组结局相当。女性（P = 0.005；比值比：4.289）和主动脉瘤（P = 0.023；比值比：5.198）被确定为血栓形成的显著预测因素。
FET支架移植物内术后新血栓形成是一种新的、罕见但临床高度相关的事件。这些血栓的栓塞可导致不良的术后结局。因此，需要更多研究以更好地识别高危患者并改善围手术期治疗。
