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The management of type II endoleak T2E remains controversial because of the heterogeneous outcome For blood-based screening to detect malignant T2E we focused on platelets after endovascular aneurysm repair EVAR and compared them with the prognosis of T2Es From 2007 to 2015 there were 249 patients treated with EVAR for abdominal aortic aneurysm who were evaluated retrospectively The mean follow-up period was 3 5 0 2 years T2Es that had aneurysm sac enlargement or converted to type I or type III endoleak were defined as malignant the other T2Es were considered benign Cases without any complications including T2E were defined as completed We compared the platelet count on postoperative days PODs 1 to 7 with preoperative baseline values among the three groups Sequentially we calculated the cutoff of the platelet ratio on POD 7 to the baseline value in relation to malignant T2E using receiver operating characteristic analysis and the cutoff ratio was 113 sensitivity 79 specificity 58 We then reclassified T2E patients into T2E-high platelet T2E-HP 113 or T2E-low platelet T2E-LP 113 groups The influence of platelets on T2E was evaluated with reintervention rate and cumulative aneurysm sac enlargement rate using the Kaplan-Meier method T2Es were found in 70 patients 28 and 179 patients were assigned to the completed group Malignant and benign T2Es were found in 33 and 37 patients respectively No difference was found in the preoperative baseline values On POD 7 the platelet count in the malignant T2E group was significantly lower than that in the completed and benign T2E groups 168 103 L vs 207 103 L and 201 103 L P 0124 Then 27 and 43 patients were assigned to the T2E-HP and T2E-LP groups respectively The reintervention-free survival rate in the T2E-LP group was lower than that in the completed group at 3 years 66 4 8 0 vs 71 9 4 0 P 0031 Among T2E patients the cumulative aneurysm sac enlargement rates in the T2E-LP group were significantly higher than those in the T2E-HP group at 3 years 34 6 8 2 vs 20 6 8 2 P 0105 Univariate Cox proportional hazards analysis for the cumulative aneurysm sac enlargement rates among T2E patients showed that sex dual antiplatelet therapy and lower platelet ratio 113 were significant predictors multivariate analysis showed that T2E-LP was the only significant predictor hazard ratio 2 60 P 0355 The platelet count of patients with malignant T2Es on POD 7 was definitively lower than that of patients with completed EVAR or with benign T2Es The lower platelet count on POD 7 could be a risk factor for aneurysm sac enlargement among patients with T2Es Copyright 2019 Society for Vascular Surgery Published by Elsevier Inc All rights reserved

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Platelets reflect the fate of type II endoleak after endovascular aneurysm repair.

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