van Marrewijk Corine, Buth Jacob, Harris Peter L, Norgren Lars, Nevelsteen André, Wyatt Michael G
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
J Vasc Surg. 2002 Mar;35(3):461-73. doi: 10.1067/mva.2002.118823.
The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm.
Data on 2463 patients were collected from 87 European centers and recorded in a central database. Preoperative data were compared for patients with collateral retrograde perfusion (type II) endoleak (group A), patients with device-related (type I and III) endoleaks (group B), and patients in whom no endoleak was detected (group C). Only endoleaks observed after the first postoperative month of follow-up were taken into consideration. Regression analysis was performed to investigate statistical relationships between the occurrence and type of endoleak and preoperative patient and morphologic characteristics, operative details, type of device, and experience of the operating team. In addition, postoperative changes in aneurysmal morphology, the need for secondary interventions, conversions to open repair, aneurysmal rupture, and mortality during follow-up were compared between these study groups.
Patients in group A had a higher prevalence of a patent inferior mesenteric artery compared with patients without endoleak. Patients in group B were treated more frequently than patients in group C by an operating team with experience of less than 30 procedures. The mean follow-up period was 15.4 months. Secondary interventions were needed in 13% of the patients. Rupture of the aneurysm during follow-up occurred in 0.52% (1/191) in group A, 3.37% (10/297) in group B, and 0.25% (5/1975) in group C. Life table analysis comparing the three study groups demonstrated a significantly higher rate of rupture in group B than in group C (P =.002). The incidence of conversion to open repair during follow-up was higher in group B than in the other two study groups (P <.01). Death was related to the aneurysm or to endovascular repair of the aneurysm in 7% of patients. Secondary outcome success, defined as absence of rupture and conversion, was significantly higher in group A and C compared with that in group B (P =.006 and P =.0001, respectively).
The presence of device-related endoleaks correlated with a higher risk of aneurysmal rupture and conversion compared with patients without type I or III endoleaks. Type II endoleak was not associated more often with these events. Consequently, intervention in type II endoleak should only be performed in case of increase of aneurysm size.
本研究旨在评估腹主动脉瘤血管腔内修复术后内漏的发生率、危险因素及后果。
收集来自87个欧洲中心的2463例患者的数据，并记录在一个中央数据库中。比较有侧支逆行灌注（II型）内漏的患者（A组）、与器械相关（I型和III型）内漏的患者（B组）以及未检测到内漏的患者（C组）的术前数据。仅考虑术后第一个月随访后观察到的内漏。进行回归分析以研究内漏的发生和类型与术前患者及形态学特征、手术细节、器械类型和手术团队经验之间的统计关系。此外，比较这些研究组之间动脉瘤形态的术后变化、二次干预的必要性、转为开放修复的情况、动脉瘤破裂以及随访期间的死亡率。
与无内漏的患者相比，A组患者肠系膜下动脉通畅的患病率更高。B组患者接受手术的团队经验少于30例手术的频率高于C组患者。平均随访期为15.4个月。13%的患者需要二次干预。随访期间动脉瘤破裂的发生率在A组为0.52%（1/191），在B组为3.37%（10/297），在C组为0.25%（5/1975）。比较三个研究组的生命表分析显示，B组的破裂率显著高于C组（P = 0.002）。随访期间转为开放修复的发生率在B组高于其他两个研究组（P < 0.01）。7%的患者死亡与动脉瘤或动脉瘤的血管腔内修复有关。定义为无破裂和无转为开放修复的次要结局成功率在A组和C组显著高于B组（分别为P = 0.006和P = 0.0001）。
与无I型或III型内漏的患者相比，与器械相关的内漏的存在与动脉瘤破裂和转为开放修复的较高风险相关。II型内漏与这些事件的关联并不更常见。因此，仅在动脉瘤大小增加的情况下才应进行II型内漏的干预。
