Pulmonary Embolism After Endovascular Aortic Repair, a Retrospective Cohort Study

Autor: Remco B. Grobben, Tim Leiner, H. M. Nathoe, Joost A. van Herwaarden, Wilton A. van Klei, Johanna M. Kwakkel-van Erp, L. M. Peelen, Cynthia Frima
Rok vydání: 2019
Předmět:
Zdroj: European Journal of Vascular and Endovascular Surgery, 57(2), 304. W.B. Saunders Ltd
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2018.08.054
Popis: 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 7–22) 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 1.4–143, p = .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.
Databáze: OpenAIRE
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