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. 2024 Mar 13;11:1344292. doi: 10.3389/fcvm.2024.1344292

Table 1.

Best evidence studies.

  Walter et al. (21) Martens et al. (22) Misfeld et al. (23)
Number of patients 304 281 125
Incidence of ILT 6% 8.2% 16.8%
Time from operation to ILT diagnosis 7 days 4.6 days N/A
Postoperative anticoagulation protocol Heparinization for 6 h postoperatively, subsequently anti-platelet therapy (ASS) Anti-platelet therapy (ASS) + low-dose heparin (thrombosis prophylaxis) Heparinization for 6 h postoperatively, subsequently anti-platelet therapy (ASS) + low-dose heparin
ILT location
  • •

    21% proximal half of the stent

  • •

    79% distal half of the stent

  • •

    Inner curvature

  • •

    Distal stent end

N/A
Risk factors
  • •

    Agea

  • •

    Female sexa

  • •

    Aortic aneurysma

  • •

    Increased stent graft diameter indexa

  • •

    Degenerative aneurysma

  • •

    Larger aortic diameter

  • •

    Anticipated Type Ib Endoleak

  • •

    HIT

  • •

    Incomplete aneurysmal stent coverage

  • •

    FET stent diameter <34mm

  • •

    Higher volumetric size of the descending aorta

  • •

    → smaller stent-to-aneurysm diameter ratio

  • •

    Conservative management of major postoperative bleeding

Clinical complications
  • •

    21% of patients with ILT developed embolic complications

  • •

    ILT Formation as an independent risk factor for perioperative mortality

  • •

    27% of patients with ILT developed embolic complications requiring re-intervention or operation

  • •

    ILT was associated with higher in-hospital mortality*

Therapeutic management
  • •

    Therapeutic anticoagulation

  • •

    20% TEVAR

  • •

    18% no treatment

  • •

    55% therapeutic anticoagulation (VKI or DOAK)

  • •

    27% interventional/ surgical embolectomy

  • •

    Therapeutic anticoagulation (VKI)

Recommendations
  • •

    Perform postoperative surveillance by CTA in all patients following FET implantation

  • •

    Consider therapeutic anticoagulation in patients at risk of ILT.

  • •

    Perform early postoperative CTA or TEE to rule out ILT (within 10 days).

  • •

    In patients developing ILT consider early TEVAR extension.

  • •

    Consider early postoperative intravenous anticoagulation in all FET-patients

  • •

    Consider extended oral anticoagulation in patients with high thrombosis risk

  • •

    Consider early surgical re-intervention for bleeding

  • •

    Avoid prolonged conservative bleeding management and coagulation factor administration

a

Independent risk factors in multivariate regression analysis.

*

19% vs. 8.7% p = 0.3.