Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft

Martens, Andreas; Beckmann, Erik; Kaufeld, Tim; Arar, Morsi; Natanov, Ruslan; Fleißner, Felix; Korte, Wilhelm; Krueger, Heike; Boethig, Dietmar; Haverich, Axel; Shrestha, Malakh

doi:10.1016/j.jtcvs.2023.01.014

Cited by 4 publications

(14 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…and Misfeld et al . reported higher incidences of incomplete aneurysmal stent coverage and expected type I b endoleak in patients with ILT-formation ( 22 , 23 ). The latter group also found that a lower stent-to-aneurysm diameter ratio was associated with FET endograft thrombosis.…”

Section: Risk Factorsmentioning

confidence: 97%

“…If CT-angiography is inconclusive, Martens et al . propose the use of transesophageal echocardiography of the descending aorta ( 22 ). While visualization of the aortic arch is limited, transesophageal sonography allows excellent analysis of the descending stent graft and provides evaluation of thrombus mobility throughout the cardiac cycle by live video imaging.…”

Section: Definition and Diagnostics Of Iltmentioning

confidence: 99%

“…Likewise, Martens et al . identified the distal end of the graft as a typical location of ILT ranging into the native descending aorta ( 22 ) ( Figure 1A ). Moreover, they observed that the thrombi were predominantly located at the inner curvature of the stent graft and propose that stent graft pockets resulting from graft folding around the ring stents in the inner curvature of the distal aortic arch may be a predisposed location for ILT formation due to low- and no-flow areas within the prosthesis.…”

Section: Incidence and Characteristics Of Postoperative Iltmentioning

confidence: 99%

“…Contrary to that, intraoperative administration of coagulation factors, platelet concentrates, and fresh frozen plasma was not associated with increased rates of ILT in the Hannover experience published by Martens et al . ( 22 ). The standard postoperative coagulation management was comparable in all three studies.…”

Section: Risk Factorsmentioning

confidence: 99%

“…As a clinical tool to identify patients at higher risk for ILT formation after FET implantation, Martens et al . proposed a score based on the Virchow's triad of risk factors for peripheral thrombus formation, which is therefore referred to as the “Virchow score” ( 22 ). In this scoring system, the stent graft diameter relative to the patient's body height (+1 point if >20 mm/m) and the presence of HIT (+2 points) as well as therapeutic anticoagulation as a protective factor (−1 point) were considered.…”

Section: Risk Factorsmentioning

confidence: 99%

See 4 more Smart Citations

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Helms,

Schmack,

Weymann

et al. 2024

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation. Adverse thromboembolic events include acute occlusion of the celiac and superior mesenteric arteries, both renal arteries as well as acute lower limb ischemia due to iliac or femoral artery embolization that not infrequently require interventional or open embolectomy. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity. Currently proposed strategies to avoid ILT formation include a more aggressive anticoagulation management, minimization of postoperative coagulation factor application, and even technical optimizations of the stent graft portion itself. If ILT is manifested, the therapeutic strategies tested to date are long-term escalation of anticoagulation and early endovascular extension of the FET stent graft with overstenting of the intraluminal thrombus. The long-term efficiency of these prophylactic and therapeutic measures has yet to be proven. Nonetheless, all surgeons performing the frozen elephant trunk procedure must be aware of the risk of ILT formation to facilitate a timely diagnosis and therapy.

show abstract

Section: Risk Factorsmentioning

confidence: 97%

Section: Definition and Diagnostics Of Iltmentioning

confidence: 99%

Section: Incidence and Characteristics Of Postoperative Iltmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

See 3 more Smart Citations