Zanchetta Mario, Faresin Francesca, Pedon Luigi, Ronsivalle Salvatore
Department of Cardiovascular Disease, Cittadella, Padua, Italy.
J Endovasc Ther. 2007 Apr;14(2):176-83. doi: 10.1177/152660280701400209.
To report a prospective, nonrandomized pilot study to determine whether fibrin glue aneurysm sac embolization at the time of endovascular aneurysm repair (EVAR) is a safe and effective procedure to primarily prevent type II endoleaks.
Between June 2003 and December 2005, 84 consecutive patients (79 men; mean age 73.8+/-7.8 years, range 64-86) with degenerative infrarenal abdominal aortic aneurysm underwent EVAR with bifurcated stent-grafts and fibrin glue injection into the aneurysm sac at the conclusion of the endovascular procedure. A total of 424 imaging studies and 348 visits were recorded during the study period and reviewed.
Selective catheterization of the aneurysm sac and fibrin glue injection immediately after initial stent-graft deployment was successful in 83 (99%) of 84 cases; there was one failure to access the excluded aneurysm sac due to severe iliac artery calcification. The estimated primary and assisted clinical success rates at 2 years were 91.3% and 98.8%, respectively, but the major findings were the low rate of delayed type II endoleak (2.4%) and the statistically significant decrease in the maximum transverse aneurysm diameter (50.40+/-6.70 versus 42.03+/-6.50 mm, p = 0.0001) at follow-up. In addition, of 31 patients available for 24-month follow-up, 14 (45.2%) patients showed a reduction in maximum transverse aneurysm diameter by >or=5 mm; 16 (51.6%) patients had no significant changes, whereas only 1 patient showed a >5-mm enlargement.
This clot engineering approach to aneurysm sac embolization at the time of endografting appears to be safe and may spare the patient a repeated catheter-based intervention or surgical procedure.
报告一项前瞻性、非随机的试点研究，以确定在血管内动脉瘤修复术（EVAR）时使用纤维蛋白胶栓塞动脉瘤囊是否是一种主要预防Ⅱ型内漏的安全有效的方法。
在2003年6月至2005年12月期间，84例连续性患有退行性肾下腹主动脉瘤的患者（79例男性；平均年龄73.8±7.8岁，范围64 - 86岁）接受了带分叉支架移植物的EVAR，并在血管内手术结束时向动脉瘤囊内注射纤维蛋白胶。在研究期间共记录并回顾了424次影像学检查和348次随访。
在84例病例中的83例（99%）中，在最初部署支架移植物后立即成功地对动脉瘤囊进行了选择性插管并注射了纤维蛋白胶；有1例因严重髂动脉钙化未能进入被隔绝的动脉瘤囊。2年时估计的主要和辅助临床成功率分别为91.3%和98.8%，但主要发现是延迟性Ⅱ型内漏发生率低（2.4%）以及随访时动脉瘤最大横径有统计学意义的减小（50.40±6.70对42.03±6.50mm，p = 0.0001）。此外，在可进行24个月随访的31例患者中，14例（45.2%）患者的动脉瘤最大横径减小≥5mm；16例（51.6%）患者无显著变化，而只有1例患者的动脉瘤横径增大>5mm。
这种在植入内支架时对动脉瘤囊进行栓塞的凝块工程方法似乎是安全的，并且可能使患者免于重复的基于导管的干预或外科手术。
