Baum Richard A, Carpenter Jeffrey P, Golden Michael A, Velazquez Omaida C, Clark Timothy W I, Stavropoulos S William, Cope Constantine, Fairman Ronald M
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
J Vasc Surg. 2002 Jan;35(1):23-9. doi: 10.1067/mva.2002.121068.
The exact significance of collateral endoleaks is unknown and a topic of great debate. Because of this uncertainty, some physicians choose to watch and wait while others aggressively treat these leaks. The purpose of this investigation was the evaluation of the efficacy of the two techniques used in the treatment of collateral endoleaks that occur after endovascular aneurysm repair.
Patients with 33 angiographically proven type 2 endoleaks underwent treatment with either transarterial inferior mesenteric artery embolization (n = 20) or direct translumbar embolization (n = 13) during an 18-month period. Embolization success was defined as resolution of endoleak on all subsequent computed tomography angiogram results. The likelihood of embolization failure between the two treatments was expressed as a risk ratio and was compared with Fisher exact test.
Sixteen of 20 transarterial inferior mesenteric artery embolizations (80%) failed with recanalization of the original endoleak cavity over time. A single failure (8%) in the direct translumbar embolization group occurred in a patient in whom a new attachment site leak developed. The remaining 12 translumbar endoleak embolizations (92%) were successful and durable, with a median follow-up period of 254 days. The patients who underwent transarterial inferior mesenteric artery embolization were significantly more likely to have persistent endoleak than were the patients who underwent treatment with direct translumbar embolization (risk ratio, 4.6; 95% confidence interval, 1.9 to 11.2; P =.0001).
The transarterial embolization of inferior mesenteric arteries for the repair of type 2 endoleaks is ineffective and should not be performed. Direct translumbar embolization of the endoleak is effective in the elimination of type 2 leaks and should be the therapy of choice when aggressive endoleak management is indicated.
侧支内漏的确切意义尚不清楚，是一个备受争议的话题。由于这种不确定性，一些医生选择观察等待，而另一些医生则积极治疗这些漏口。本研究的目的是评估血管内动脉瘤修复术后发生的侧支内漏的两种治疗技术的疗效。
在18个月期间，对33例经血管造影证实为2型内漏的患者进行了治疗，其中20例采用经动脉肠系膜下动脉栓塞术，13例采用直接经腰动脉栓塞术。栓塞成功定义为所有后续计算机断层扫描血管造影结果显示内漏消失。两种治疗方法之间栓塞失败的可能性用风险比表示，并采用Fisher精确检验进行比较。
20例经动脉肠系膜下动脉栓塞术中，16例（80%）失败，随着时间推移，原内漏腔再通。直接经腰动脉栓塞组有1例（8%）失败，该患者出现了新的附着部位漏血。其余12例经腰动脉内漏栓塞术（92%）成功且持久，中位随访期为254天。与接受直接经腰动脉栓塞术治疗的患者相比，接受经动脉肠系膜下动脉栓塞术的患者持续存在内漏的可能性显著更高（风险比为4.6；95%置信区间为1.9至11.2；P = 0.0001）。
经动脉栓塞肠系膜下动脉修复2型内漏无效，不应实施。直接经腰动脉栓塞内漏对消除2型漏血有效，在需要积极处理内漏时应作为首选治疗方法。
