Changes in circulating markers of coagulation and fibrinolysis after EVAR.

INTRODUCTION: The presence of an abdominal aortic aneurysm (AAA) is associated with increased thrombin formation, fibrin turnover and fibrinolysis. EVIDENCE ACQUISITION: The aim of this study was to review the relevant literature and summarize the evidence regarding the impact of endovascular repair on the circulating markers of coagulation and fibrinolysis postprocedure. EVIDENCE SYNTHESIS: The main findings are that the increased thrombin activation, and formation, as well as fibrinolysis, in patients with AAA is exacerbated after endovascular repair in the short-term and the mid-term, implying that this may be a period associated with an increased likelihood for adverse cardiovascular events. It is estimated that this prothrombotic state is normalized within a year of the endovascular procedure. Furthermore, elevated levels of specific markers of fibrinolysis are associated with the presence of an endoleak during the follow-up imaging and the clinical implications of these findings merit investigation. CONCLUSIONS: Further and larger studies are needed to explore the impact of these changes in coagulation and fibrinolysis on the outcome of endovascular repair in patients with AAA.

Endovascular Repair of Abdominal Aortic Aneurysms with the Anaconda™ Stent Graft: Mid-term Results from a Single Center.

INTRODUCTION: We aimed to report our experience with the Anaconda™ stent graft (Vascutek, Terumo, Inchinnan, Scotland, UK) for the endovascular treatment of abdominal aortic aneurysms (AAAs). METHODS: The vascular unit database was interrogated to identify all AAA patients who underwent endovascular repair with the Anaconda™ device between March 2007 and June 2014. The peri-operative, short-term, and mid-term outcome was recorded focusing on complications and re-interventions. RESULTS: Sixty-eight patients had been treated during the study period. Seven of these were symptomatic, one presented with an inflammatory aneurysm, and five presented with a ruptured AAA. The primary and the assisted primary technical success were 86.7 and 97.1%, respectively. There was no 30-day mortality in the elective or symptomatic group, but two of the ruptured AAA patients died. During a mean follow-up of 29 months (range 1-87), 14 patients died, none from aneurysm-related causes. A total of 11 endoleaks (17.5%) were detected in 10 patients during follow-up (1 type Ia, 4 type Ib, 6 type II), 4 of which required re-intervention (all for type Ib endoleak). Two iliac limbs occluded during the follow-up. The estimated overall survival, endoleak-free survival and re-intervention-free survival probability were 88.2, 78.4, and 83.4% at 1 year; 85.9, 73.8, and 78.9% at 2 years; and 80.6, 71.3, and 70.5% at 3 years, respectively. CONCLUSION: Based on this series, the Anaconda™ stent graft appears to be safe and effective for the endovascular treatment of AAAs. Both the short-term and the mid-term results are satisfactory.