Cho Jae-Sung, Dillavou Ellen D, Rhee Robert Y, Makaroun Michel S
Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital A1011, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Vasc Surg. 2004 Jun;39(6):1236-41; discussion 2141-2. doi: 10.1016/j.jvs.2004.02.038.
Behavior of the abdominal aortic aneurysm (AAA) sac after endovascular abdominal aortic aneurysm repair (EVAR) is graft-dependent. The Excluder endograft has been associated with less sac regression than some other stent grafts. Long-term follow-up has not been reported.
Between May 1999 and July 2002, 50 patients underwent EVAR with the Excluder bifurcated endoprosthesis. These patients were followed up prospectively with computed tomography (CT) at 1, 6, and 12 months and yearly thereafter. One immediate conversion to open surgery and three deaths occurred within 6 months. One additional patient was lost to follow-up. The remaining 45 patients, 35 men and 10 women, were followed up for at least 1 year, and form the basis for this report. Their mean age was 73 +/- 5.5 years. The minor axis diameter at the largest area of the AAA on CT examination was compared with the baseline measurement at 1 month and to the smallest size previously recorded during follow-up. Change in sac size of 5 mm or greater was considered significant. Mean follow-up was 2.7 +/- 1.2 years (range, 1-4 years). Nominal variables were compared with the chi(2) test, and continuous variables with the Student t test.
A significant decrease in average AAA sac diameter was observed at 6-month, 1-year, and 2-year follow-up. These differences were lost by the 3-year evaluation, because of delayed sac growth (n = 9) and re-expansion of once shrunken aneurysms (n = 3). The probability of freedom from sac growth or re-expansion at 4 years was only 43%. At last follow-up, sac expansion occurred in the absence of active endoleak in nine patients. Type II endoleak was associated with sac expansion in three patients (P =.003), resulting in one conversion to open surgery after the 4-year follow-up. No graft migrations, AAA ruptures, or aneurysm-related deaths were noted.
Late aneurysm sac growth or re-expansion after EVAR with the Excluder device is common, even in the absence of endoleak. Although the incidence of important clinical sequelae is low at this point, the incidence of aneurysm expansion should be taken into consideration during the risk-benefit assessment before EVAR repair with the Excluder device.
血管腔内腹主动脉瘤修复术（EVAR）后腹主动脉瘤（AAA）瘤腔的变化情况取决于移植物类型。与其他一些覆膜支架相比，Excluder覆膜支架与瘤腔缩小程度较小有关。目前尚未见长期随访报道。
1999年5月至2002年7月期间，50例患者接受了Excluder分叉型腔内修复术进行EVAR治疗。对这些患者进行前瞻性随访，术后1、6和12个月以及之后每年行计算机断层扫描（CT）检查。6个月内有1例患者立即转为开放手术，3例死亡。另有1例患者失访。其余45例患者（35例男性和10例女性）至少随访1年，构成本报告的基础。他们的平均年龄为73±5.5岁。将CT检查时AAA最大面积处的短轴直径与1个月时的基线测量值以及随访期间之前记录的最小尺寸进行比较。瘤腔大小变化5mm或更大被认为有意义。平均随访时间为2.7±1.2年（范围1 - 4年）。名义变量采用卡方检验进行比较，连续变量采用Student t检验进行比较。
在6个月、1年和2年随访时观察到AAA瘤腔平均直径显著减小。到3年评估时，这些差异消失，原因是瘤腔延迟增大（n = 9）和曾经缩小的动脉瘤再次扩张（n = 3）。4年时瘤腔无增大或再次扩张的概率仅为43%。在最后一次随访时，9例患者在无活动性内漏的情况下出现瘤腔扩张。3例患者的Ⅱ型内漏与瘤腔扩张有关（P = 0.003），导致4年随访后有1例转为开放手术。未发现移植物移位、AAA破裂或与动脉瘤相关的死亡。
使用Excluder装置进行EVAR术后，晚期动脉瘤瘤腔增大或再次扩张很常见，即使在无内漏的情况下也是如此。尽管此时重要临床后遗症的发生率较低，但在使用Excluder装置进行EVAR修复术前的风险 - 效益评估中，应考虑动脉瘤扩张的发生率。
