Spinella Giovanni, Conti Michele, Magliocco Marco, Pisa Fabio Riccardo, Finotello Alice, Pulze Martina, Pratesi Giovanni, Cittadini Giuseppe, Salsano Giancarlo, Pane Bianca
Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy.
UOC Clinica di Chirurgia Vascolare ed Endovascolare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Front Cardiovasc Med. 2023 Aug 7;10:1176455. doi: 10.3389/fcvm.2023.1176455. eCollection 2023.
The development of intrastent thrombosis is one of the mechanisms related to medium- to long-term failure of endovascular treatment of popliteal artery aneurysm. The present study aims to investigate possible links between the development of endoluminal mural thrombotic apposition in the stented zone (EMTS) with both geometrical features of stent-graft(s) and time of follow-up.
Patients with popliteal artery aneurysm who underwent endovascular treatment were recruited during the follow-up period. Segmentation of computed tomography angiography scan was performed to detect femoropopliteal artery lumen, leg bones, EMTS, and stent-graft(s). The following parameters were assessed: number, diameter, and length of stent-graft(s); and shape, volume, and length of thrombotic apposition within the stent(s). The spiral shape of the thrombotic apposition was evaluated as well.
Eighteen male patients were recruited in the study. EMTS was observed in 13 of them (72%) during the follow-up analysis. An average of 1.8 ± 0.79 stents-grafts were implanted per patient with a median diameter and length of 6.2 (1.9) mm and 125 (50) mm, respectively. The percentage of the stent length where EMTS was present was 42.1 on average (interquartile range: 42.4%) with a mean volume of 206.8 mm. A positive correlation was found between the length and volume of EMTS (R-squared = 0.71, < 0.01). Moreover, EMTS had a helical shape in 8/13 patients, with 4/5 with counterclockwise rotation with stent-grafts in the left leg and 3/3 with clockwise direction treated in the right leg. A higher frequency of EMTS was observed in patients with longer follow-up and higher risk factors, as well.
EMTS is observed in most of the patients under analysis, especially in those with medium- to long-term follow-up. The pattern of such EMTS follows a helical shape having a direction that depends on which leg, right or left, is treated. Our results suggest a close surveillance of popliteal aneurysm stenting by follow-up examinations to control the onset and progression of EMTS.
支架内血栓形成是腘动脉瘤血管内治疗中长期失败的相关机制之一。本研究旨在探讨支架置入区腔内壁血栓附着（EMTS）的发展与支架移植物的几何特征和随访时间之间的可能联系。
在随访期间招募接受血管内治疗的腘动脉瘤患者。对计算机断层扫描血管造影扫描进行分割，以检测股腘动脉管腔、腿部骨骼、EMTS和支架移植物。评估以下参数：支架移植物的数量、直径和长度；以及支架内血栓附着的形状、体积和长度。还评估了血栓附着的螺旋形状。
本研究共招募了18名男性患者。在随访分析中，其中13名（72%）观察到EMTS。每位患者平均植入1.8±0.79个支架移植物，中位直径和长度分别为6.2（1.9）mm和125（50）mm。存在EMTS的支架长度百分比平均为42.1（四分位间距：42.4%），平均体积为206.8mm。发现EMTS的长度和体积之间存在正相关（决定系数=0.71，<0.01）。此外，13例患者中有8例EMTS呈螺旋状，左腿接受支架移植物治疗的5例中有4例逆时针旋转，右腿接受治疗的3例均为顺时针方向。随访时间较长和危险因素较高患者中EMTS的发生率也较高。
在大多数分析患者中观察到EMTS；尤其是在中长期随访的患者中。这种EMTS的模式呈螺旋状，其方向取决于治疗的是右腿还是左腿。我们的结果表明，通过随访检查密切监测腘动脉瘤支架置入情况，以控制EMTS的发生和进展。
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