Persistent Thrombocytopenia Indicates Endoleak After Complex Endovascular Aneurysm Repair

Abstract

Objectives:

High-pressure endoleaks (type I and III) after fenestrated-branched endovascular aneurysm repair (F-BEVAR) pose ongoing rupture risk. Early identification of such endoleaks may facilitate appropriate reintervention. Our objective was to determine if persistent thrombocytopenia after F-BEVAR correlates with high-pressure endoleaks in the early postoperative period.

Methods:

Patients in a physician-sponsored investigational device exemption study of physician-modified and Cook-manufactured fenestrated/branched endografts were evaluated. Endoleaks identified on computed tomography within the first 6 months of follow-up were classified as high-pressure (type I or III) or low-pressure (type II). Bivariable and multivariable analyses were performed to assess if thrombocytopenia was associated with the presence of endoleaks.

Results:

Among 185 patients, 26 (14%) developed high-pressure endoleaks and 30 (16%) developed low-pressure endoleaks. Demographics, procedure indications, and preoperative medications were similar across endoleak groups. To maximize sensitivity and clinical utility, we selected a daily average platelet count <100,000/μL as a cut point. The proportion of high-pressure endoleak patients with platelet counts <100,000/μL was significantly greater compared to low-pressure and no endoleak patients on postoperative day 1 (POD#1) through POD#4 (high-pressure 42%, low-pressure 27%, no endoleak 10%; p<0.001). After adjusting for demographics and comorbidities, patients with high-pressure endoleak were over 12 times more likely to have average platelets <100,000/μL on POD#4 compared to patients with no endoleak (OR 12.3, 95% CI 3.5–43.0).

Conclusions:

F-BEVAR patients who developed high-pressure endoleak had significantly lower platelet counts postoperatively. Aortic imaging should be considered in patients with platelet counts <100,000/μL at POD#4 following F-BEVAR, as 35% of such patients will have a high-pressure endoleak requiring reintervention.

Clinical Impact

Persistent thrombocytopenia following F-BEVAR may be an early indication of a high pressure endoleak. Imaging is recommended for patients with platelet count <100,000/μL on POD 4 as 35% of such patients in this study had a high pressure endoleak.