S. S. Patel1, I. Lee1, K. L. Morrow1, F. Hagos1, T. Rakasiwi1, T. Yeng1, A. Dua1,2 1Massachusetts General Hospital, Division Of Vascular And Endovascular Surgery, Boston, MA, USA 2Harvard School Of Medicine, Department Of Surgery, Brookline, MA, USA
Introduction:
Thrombosis of lower extremity revascularizations is the leading cause of amputation in patients with peripheral artery disease. The overall rate of thrombosis is 20% at 6 months however, the contribution of the type of revascularization (open versus endovascular) to thrombotic rates has never been ascertained. Thromboelastography with platelet mapping (TEG-PM) is an objective coagulation test that assesses viscoelastic properties associated with thrombus formation. The aim of this study is to delineate the impact of open versus endovascular revascularization on thrombotic rates in patients with PAD using viscoelastic testing.
Methods:
All patients with PAD undergoing revascularization procedures between December 2022 to July 2023 were prospectively evaluated at a large, single center. Demographics, procedure type, and thromboprophylaxis were documented. TEG-PM values were obtained at multiple intervals (preoperative and at months 1, 3, 6 post operatively). Primary outcome was thrombosis of the lower extremity revascularization.
Results:
Of the 185 patients enrolled, 742 samples were processed. Upon review of the coagulation parameters from TEG-PM, patients in the endovascular cohort demonstrated significantly greater Maximum Clot Amplitude (MA) in CFF [28.6 (±10.5) vs. 25.3(±9.9) p<0.05], ActF [15.6(±7.3) vs. 14.3(±7.5) p<0.05], AA [38.1(±20.4) vs. 34.2(±17.1) p<0.05], CK [62.9(±7.2) vs 60.1(±7.9) vs. p<0.05], and CRT [65.2(±6.9) vs 62.0(±6.9) p<0.05] indicating that patients who underwent endovascular procedures had increased rates of aggressive thrombus formation and formed stronger clots. When matching patients based on thromboprophylaxis the differences in TEG-PM parameters between endovascular and open patients were not significant indicating that appropriate medications mitigated thrombotic risk.
Conclusion:
Patients who have undergone endovascular interventions demonstrated prothrombotic TEG parameters compared to open interventions.This study demonstrates that while endovascular patient may have higher propensity to thrombose, this can be potentially mitigated with the correct, tailored thromboprophylaxis guided by objective coagulation assays such as TEG-PM.