Timaran Carlos H, Ohki Takao, Rhee Soo J, Veith Frank J, Gargiulo Nicholas J, Toriumi Hisako, Malas Mahmood B, Suggs William D, Wain Reese A, Lipsitz Evan C
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111E 210th Street, Bronx, NY 10467, USA.
J Vasc Surg. 2004 Jun;39(6):1157-62. doi: 10.1016/j.jvs.2003.12.033.
The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR).
In a series of 348 EVARs performed during a 10-year period, 32 patients (9.2%) developed type II endoleaks that persisted for more than 6 months. Variables analyzed included those defined by the reporting standards for EVAR (SVS/AAVS) as well as other endoleak characteristics. Univariate, receiver operating characteristic curve, and Cox regression analyses were used to determine the association between variables and aneurysm enlargement.
The median follow-up period was 26.5 months (range, 6-88 months). Thirteen patients (41%) had aneurysm enlargement by 5 mm or more (median increase in diameter, 10 mm), whereas 19 (59%) had stable or shrinking aneurysm diameter. Univariate and Cox regression analyses identified the maximum diameter of the endoleak cavity, ie, the size of the nidus as defined on contrast computed tomography scan, as a significant predictor for aneurysm enlargement (relative risk, 1.12; 95% confidence interval, 1.04-1.19; P =.001). The median size of the nidus was 23 mm (range, 13-40 mm) in patients with aneurysm enlargement and 8 mm (range, 5-25 mm) in those without expansion (Mann-Whitney U test, P <.001). Moreover, receiver operating characteristic curve and Cox regression analyses showed that a maximum nidus diameter greater than 15 mm was particularly associated with an increased risk of aneurysm enlargement (relative risk, 11.1; 95% confidence interval, 1.4-85.8; P =.02). Other risk factors including gender, smoking history, hypertension, need of anticoagulation, aneurysm diameter, type of endograft used, and number or type of collateral vessels were not significant predictors of aneurysm enlargement.
In patients with persistent type II endoleaks after EVAR, the maximum diameter of the endoleak cavity or nidus is an important predictor of aneurysm growth and might indicate the need for more aggressive surveillance as well as earlier treatment.
II型内漏的临床意义尚未完全明确。然而，一些证据表明，某些II型内漏可能导致动脉瘤扩大和破裂。为了确定可能导致动脉瘤扩张的因素，我们分析了多个变量对血管内主动脉瘤修复术（EVAR）后持续性II型内漏患者动脉瘤生长的影响。
在10年期间进行的一系列348例EVAR手术中，32例患者（9.2%）出现了持续超过6个月的II型内漏。分析的变量包括EVAR报告标准（SVS/AAVS）定义的变量以及其他内漏特征。采用单因素分析、受试者工作特征曲线分析和Cox回归分析来确定变量与动脉瘤扩大之间的关联。
中位随访期为26.5个月（范围6 - 88个月）。13例患者（41%）的动脉瘤扩大了5 mm或更多（直径中位数增加10 mm），而19例患者（59%）的动脉瘤直径稳定或缩小。单因素分析和Cox回归分析确定，内漏腔的最大直径，即对比计算机断层扫描定义的病灶大小，是动脉瘤扩大的重要预测因素（相对风险，1.12；95%置信区间，1.04 - 1.19；P = 0.001）。动脉瘤扩大患者的病灶中位大小为23 mm（范围13 - 40 mm），未扩张患者为8 mm（范围5 - 25 mm）（Mann-Whitney U检验，P < 0.001）。此外，受试者工作特征曲线分析和Cox回归分析表明，病灶最大直径大于15 mm与动脉瘤扩大风险增加尤其相关（相对风险，11.1；95%置信区间，1.4 - 85.8；P = 0.02）。其他风险因素，包括性别、吸烟史、高血压、抗凝需求、动脉瘤直径、所用血管内移植物类型以及侧支血管数量或类型，均不是动脉瘤扩大的显著预测因素。
在EVAR后出现持续性II型内漏的患者中，内漏腔或病灶的最大直径是动脉瘤生长的重要预测因素，可能表明需要更积极的监测以及更早的治疗。
