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Thromboembolic Complications During Endovascular Repair of Complex Aortic Aneurysms

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Endovascular Aortic Repair

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Abstract

Embolization of atheromatous debris is a known cause of major morbidity and mortality during complex endovascular repair. Potential complications include solid organ infarction, loss of renal function, bowel ischemia, and multisystem organ failure. Few studies have analyzed predictive factors of risk of atheroembolization during complex endovascular repair. We have recently analyzed atherosclerotic aortic wall thrombus (AWT) and clinical outcomes in 212 patients treated by fenestrated-branched endovascular aortic repair (F-BEVAR). Computed tomography angiography (CTA) was reviewed in all patients to determine the location, extent, and severity of atherosclerotic AWT. The aorta was divided into three segments and volumetric measurements of AWT were performed using Terarecon software. A classification system is proposed using objective assessment of number of affected segments, thrombus type, thickness, area, and circumference. AWT was classified as mild in 98 patients (46 %) and was considered moderate or severe in 114 (54 %). Solid organ infarction was present in 50 patients (24 %), acute renal injury occurred in 45 patients (21 %) by RIFLE criteria or 48 patients (23 %) by AKIN criteria. Patients with these complications had significantly higher (P < 0.05) AWT index scores. This chapter describes volumetric AWT assessment by image software and presents a novel score-based classification.

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Authors and Affiliations

  1. Department of Surgery and Anatomy, Ribeirão Preto Medical School, Ribeirão Preto Clinical Hospital, University of São Paulo, Campus Universitário s/n, Ribeirão Preto, São Paulo, 14048-900, Brazil

    Mauricio S. Ribeiro

  2. Postgraduate Program in Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, 2400 Ramiro Barcelos St, 2nd Floor, Porto Alegre, 90035-003, Brazil

    Leonardo Reis de Souza

  3. Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Gustavo S. Oderich

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  1. Mauricio S. Ribeiro
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  2. Leonardo Reis de Souza
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  3. Gustavo S. Oderich
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Correspondence to Gustavo S. Oderich .

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  1. Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA

    Gustavo S. Oderich

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Ribeiro, M.S., de Souza, L.R., Oderich, G.S. (2017). Thromboembolic Complications During Endovascular Repair of Complex Aortic Aneurysms. In: Oderich, G. (eds) Endovascular Aortic Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-15192-2_46

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