{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:23:11Z","timestamp":1791494591424,"version":"4.3.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Persistent type 2 endoleaks (pT2ELs) following endovascular aortic aneurysm repair (EVAR) pose surveillance challenges. Although previous studies demonstrated that low D-dimer levels at single time points indicate lower risk of aneurysm enlargement (AnE), the value of longitudinal D-dimer monitoring remains unexplored. This study examined associations between D-dimer dynamics and AnE in patients with pT2ELs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective single-center cohort study. Consecutive patients undergoing elective EVAR (2007-2022) were reviewed. Inclusion criteria were isolated pT2ELs confirmed at 12 months, &gt;2 years of follow-up, and available annual D-dimer data. Primary outcome was AnE (\u22655 mm sac diameter increase) within 5 years. D-dimer trajectories were retrospectively classified as consistently low (&lt;5.3 \u00b5g\/mL throughout), transitioned to high (\u226513.5 \u00b5g\/mL at any point), or intermediate (all others). Analyses used multivariable trajectory-based Cox regression, time-dependent Cox regression, and generalized estimating equations (GEEs), adjusting for chronic kidney disease, inferior mesenteric artery patency, and number of patent lumbar arteries (\u22656).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 118 patients, 43 (36.4%) experienced AnE. Kaplan-Meier analysis showed significantly lower freedom from AnE in the transitioned to high group (overall log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002). In trajectory-based Cox regression, the transitioned to high group had significantly increased AnE risk versus the consistently low group (adjusted hazard ratio = 4.76, 95% confidence interval [CI]: 1.62-14.00,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005). Generalized estimating equation sensitivity analysis confirmed a dose-response relationship, with high D-dimer showing the strongest association (odds ratio 3.45, 95% CI: 1.69-7.05,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>D-dimer dynamics were associated with AnE in patients with pT2ELs. Multiple complementary analyses demonstrated consistent dose-dependent associations. Retrospective trajectory classification defined distinct prognostic phenotypes: patients maintaining levels &lt;5.3 \u00b5g\/mL demonstrated superior sac stability, whereas elevations \u226513.5 \u00b5g\/mL identified a higher-risk group. These findings support a biomarker-guided dynamic surveillance strategy, pending prospective validation before clinical deployment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>Current surveillance of persistent type 2 endoleaks relies solely on imaging, lacking validated biomarkers to guide follow-up. This retrospective study shows that longitudinal D-dimer trajectory patterns were independently associated with aneurysm enlargement over 5 years, and D-dimer levels at each annual visit were associated with enlargement risk in the subsequent year. A routinely available blood test may therefore complement imaging-based surveillance: levels below 5.3 \u00b5g\/mL were associated with low enlargement risk, whereas elevations \u226513.5 \u00b5g\/mL defined a higher-risk phenotype warranting closer follow-up. If prospectively validated, this biomarker-guided approach could support individualized surveillance and more efficient use of imaging resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261467191","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:16:11Z","timestamp":1784524571000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Value of D-Dimer Dynamics for Aneurysm Enlargement in Patients With Persistent Type 2 Endoleaks After Endovascular Aneurysm Repair"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1712-4398","authenticated-orcid":false,"given":"Masayuki","family":"Sugimoto","sequence":"first","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumie","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Advanced Medicine, Nagoya University Hospital, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Osawa","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changi","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuta","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8292-2528","authenticated-orcid":false,"given":"Naohiro","family":"Akita","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9150-5420","authenticated-orcid":false,"given":"Hiroshi","family":"Banno","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.02.003"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31135-7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2014.06.035"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.04.486"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.056581"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.10.044"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2023.11.002"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-018-0030-7"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.06.029"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvssci.2021.02.001"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.117.310126"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028231170165"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028241306277"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002508"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2021.06.013"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.014902"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.11.003"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.10.092"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2023.06.003"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.10.088"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.04.505"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003299"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028221083457"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.11.006"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028241270895"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41747-024-00489-3"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.03.015"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.09.048"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2023.01.042"}],"container-title":["Journal 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