Plasma Levels of D-dimer and Fibrin Degradation Product Could Be Predictors of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair

Masahiro Mizumoto	Tetsuro Uchida	Seigo Gomi
Azumi Hamasaki	Yoshinori Kuroda	Atsushi Yamashita
Jun Hayashi	Shuto Hirooka	Takumi Yasumoto
Mitsuaki Sadahiro

（Second Department of Surgery（Cardiovascular Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan）

Objective:Although an endoleak is the most common complication after endovascular abdominal aortic aneurysm repair（EVAR), the proper and noninvasive method for the detection of endoleaks is not established. The purpose of this study is to investigate whether plasma levels of D-dimer and fibrin degradation product（FDP）could be predictors of endoleaks after EVAR. Methods:Between June 2011 and January 2014, 65 consecutive patients underwent EVAR at our institution. We evaluated 55 patients excluding 10 patients pre-existing conditions such as aortic dissection, arterial or venous thrombosis, conversion to open surgery, and difficulties in making outpatient visits. Enhanced computed tomography（CT）examination was performed during 12 months after EVAR. Persistent endoleaks and maximum aneurysmal diameter were evaluated at each follow-up time. Patients were divided into groups according to CT findings at 12 months after EVAR. There were 26 patients with endoleaks vs. 29 non-endoleak patients, 34 with unchanged aneurysm findings vs. 21 with shrinkage. No patient showed aneurysmal enlargement. Plasma levels of D-dimer, FDP, counts of platelet, prothrombin time（PT), and activated partial thromboplastin time（APTT）were also measured at the time of CT examinations. Results:There was no operative death and no major complication. Endoleaks in all patients were identified as type II. None of them required re-intervention. In the endoleak group, plasma levels of D-dimer and FDP were significantly higher than in the non-endoleak group in each postoperative period. In addition, postoperative counts of platelet were significantly lower in the endoleak group. PT and APTT test results showed no significant difference in the two groups. In the unchanged aneurysm group, postoperative D-dimer and FDP tended to be higher compared with the shrinkage group. Postoperative counts of platelet also tended to be lower in the unchanged group. There were no differences in PT and APTT test results. Conclusion:Plasma levels of D-dimer and FDP are potentially useful predictors of endoleaks after EVAR.　
　　

Jpn. J. Cardiovasc. Surg. 44:301-306（2015）

Keywords：endovascular abdominal aortic aneurysm repair（EVAR）;endoleak;D-dimer;fibrin degradation product（FDP）