VESS04 - Persistent Thrombocytopenia Indicates Endoleak After Complex Endovascular Aneurysm Repair

Objectives: High-pressure endoleaks (types 1 or 3) after fenestrated-branched endovascular aneurysm repair (F-BEVAR) pose an ongoing risk of rupture. Early identification of such endoleaks may facilitate appropriate reintervention and mitigate that risk. The purpose of this study was to determine if persistent thrombocytopenia after F-BEVAR correlates with the presence of a high-pressure endoleak in the early postoperative period.

Methods: Sequential patients enrolled in a physician-sponsored investigational device exemption study of physician modified and Cook manufactured fenestrated/branched (F-BEVAR) endografts were evaluated. Patients with type 1 endoleak or type 3 endoleak identified on computed tomography (CT) imaging within the first 6 months of follow up were categorized as high-pressure endoleaks; any type 2 endoleaks were classified as low-pressure endoleaks. Univariable and multivariable analysis was performed to assess if thrombocytopenia was associated with the presence of endoleaks.

Results: 185 patients were treated. Twenty-six patients (14%) developed a high-pressure endoleak and thirty (16%) developed a low-pressure endoleak (Table 1). Age, gender, race, indications for the procedure, and pre-operative medications did not significantly differ between the endoleak groups. To maximize sensitivity and clinical utility, we selected a cut point of daily average platelet count < 100,000/µL (Table 2). The proportion of high-pressure endoleak patients with platelet counts < 100,000/µL was significantly greater compared to patients with low-pressure and no endoleaks on postoperative day (POD) 1 through 4 (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 twelve-times more likely to have a platelet count < 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- or low-pressure endoleak were significantly more thrombocytopenic in the postoperative period. Consideration should be made to perform CT imaging in patients with platelet counts < 100,000/µL persisting at POD 4 after F-BEVAR as these patients have a 35% chance of having a high-pressure endoleak requiring reintervention.