Effect of Anticoagulation on Endovascular Aneurysm Repair Outcomes and Development of Endoleaks

Abstract

Objective: We investigated the effect of anticoagulation on endovascular aneurysm repair outcomes, including the development of type II endoleaks and reintervention rates.Methods: The patient and aneurysm characteristics, procedure details, and postoperative outcomes were collected for consecutive patients who had undergone endovascular aneurysm repair from 2010 to 2019. The patient groups were stratified by anticoagulation use and the presence or absence of a type II endoleak. The groups were compared using the c 2 test, Student t test, or univariate or multivariate logistic regression analyses, as appropriate.Results: We included 581 patients (age, 77.1 6 82 years; 82.6% male) with a mean follow-up of 3.99 6 2.4 years. During follow-up, 233 patients developed a type II endoleak. No significant differences were found in comorbidities or aneurysm size (mean, 51.5 6 19.3 mm) between the patients with and without a type II endoleak. Anticoagulation was associated with the occurrence of type II endoleaks (50% for patients on anticoagulation vs only 38.9% for patients not receiving anticoagulation; P ¼ .06). No association was found between anticoagulation, a type II endoleak, and survival. In a logistic regression model that included age, sex, abdominal aortic aneurysm (AAA) size, type II endoleak, and anticoagulation, only AAA size was associated with mortality (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.004-1.03; P ¼ .01). The results from the logistic regression models confirmed the association of anticoagulation and type II endoleaks (OR, 1.57; 95% CI, 0.97-2.5; P ¼ .06). Age was also associated with the development of type II endoleaks (OR, 1.03; 95% CI, 1.009-1.05; P ¼ .005). Additional comorbidities and patient factors, including sex, AAA size, and antiplatelet use, were not associated with the development of endoleaks. On logistic regression modelling, type II endoleaks and anticoagulation use were both independently associated with increased reintervention rates (OR, 3.2; 95% CI, 2.0-5.0; P < .0001; and OR, 2.5; 95% CI, 1.4-4.5; P ¼ .002, respectively).Conclusions: We found an association between anticoagulation and type II endoleaks. Both the presence of a type II endoleak and anticoagulation use were associated with a higher reintervention rate, with no appreciable effects on long-term survival.