Pulmonary Embolism After Endovascular Aortic Repair, a Retrospective Cohort Study

Abstract

WHAT THIS PAPER ADDS This is the first study to assess pulmonary embolism after endovascular aortic repair using routinely performed aortic computed tomography angiographiess. This paper shows that, despite routine thrombo-embolism prophylaxis, pulmonary embolism occurs frequently after endovascular aortic repair, and thoracic endovascular aortic repair, respectively.Objectives: Endovascular aortic repair (EVAR) is associated with an increased risk of pulmonary embolism, which is often clinically silent and therefore difficult to recognise. The aim was to investigate the incidence of pulmonary embolism after EVAR using routinely performed pre-and post-operative aortic computed tomography angiography (CTA), and the association between pulmonary embolism and mortality. Methods: This single centre retrospective cohort study included adult patients who underwent EVAR in the University Medical Centre Utrecht between January 2010 and July 2015 and who had a total aortic, thoracic aortic, or pulmonary CTA within one month post-operatively. Baseline and mortality data were obtained by reviewing hospital and general practitioner records. The primary outcome was pulmonary embolism within one month after surgery. Secondary outcomes were 30 day and six month mortality. Results: During the study period, 526 EVARs were performed. Seventy-four of these procedures were included in the analysis of which there were 40 thoracic and 34 abdominal EVARs. In nine patients (12%, 95% CI 7e22) pulmonary embolism was observed of which one was central, two were segmental, and six were subsegmental. Seven were clinically silent and two were present on the pre-operative CTA. Thirty day mortality was significantly higher in patients with pulmonary embolism (relative risk 14.4, 95% CI 1.4e143, p ¼ .037) though none of the deaths seemed directly attributable to it. Conclusions: This study, although preliminary, suggests that silent pulmonary embolism after EVAR occurs in approximately one in 10 patients, despite routine thrombo-embolism prophylaxis. Pulmonary embolism was associated with a higher 30 day mortality risk yet it was not the cause of death in any of these patients.

Risk factors for venous thromboembolism after vascular surgery and implications for chemoprophylaxis strategies

“…In contrast, several prior single-center reports have demonstrated much higher rates of VTE (≥10%), especially after open aortic operations and TEVAR. 18 – 21 These discrepancies could also be accounted for by the use of more inclusive VTE definitions and the duplex ultrasound screening practices included in the protocols of studies with the highest reported rates of VTE. Postoperative screening for DVT was not performed as a part of routine clinical practice for the patients included in the present study.…”

Massive Pulmonary Thromboembolism with Clot-in Transit in a Patient with Acute Aortic Dissection and Hemothorax- a Clinician's Dilemma

“…The procedure went successful, and the patient was given prophylactic anticoagulation, despite which he developed massive pulmonary thromboembolism with large clot-in transit. There is an increased risk of symptomatic pulmonary embolism after endovascular aortic repair, reported in up to 4% of patients [2,6]. In a retrospective analysis of 73 patients with endovascular aortic repair of aortic aneurysm, pulmonary embolism (asymptomatic and symptomatic) occurred in 12% of patients, associated with a mortality of 22% compared to 1.5% in those patients without pulmonary embolism [2].…”

“…There is an increased risk of symptomatic pulmonary embolism after endovascular aortic repair, reported in up to 4% of patients [2,6]. In a retrospective analysis of 73 patients with endovascular aortic repair of aortic aneurysm, pulmonary embolism (asymptomatic and symptomatic) occurred in 12% of patients, associated with a mortality of 22% compared to 1.5% in those patients without pulmonary embolism [2]. Predictors of pulmonary embolism included ICU admission and chronic obstructive pulmonary disease (COPD).…”

“…Acute aortic dissection with hemothorax is an uncommon presentation associated with high morbidity and mortality [1]. These patients are also at increased risk of venous thromboembolism [2]. Massive pulmonary embolism (PTE) with large clot-in transit post-TEVAR was not reported previously, and it may be associated with life-threatening consequences and clinical dilemma [3].…”

Infrared Spectroscopy in Differential Diagnosis of Pulmonary Embolism

“…The situation is still more aggravated by a frequent combination of the mentioned diseases since oncopathology and injury of bronchopulmonary and cardiovascular systems lead to hypercoagulation and blood flow deceleration and, in case of acute inflammatory reaction and a destructive process, to the damage of the vascular wall, i.e. to the formation of all three components of Virchow’s triad: an integral component of thrombus formation [ 18 – 20 ].…”