Kougias Panagiotis, Lin Peter H, Dardik Alan, Lee W Anthony, El Sayed Hosam F, Zhou Wei
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Hospital, 2002 Holcomb Boulevard, Houston, TX 77030, USA.
J Vasc Surg. 2007 Jul;46(1):124-7. doi: 10.1016/j.jvs.2007.02.067.
Abdominal aortic aneurysm (AAA) enlarges after successful endovascular repair because of endoleak, which is persistent blood flow within the aneurysm sac. In the absence of detectable endoleak, AAA may still expand, in part because of endotension, which is persistent pressurization within the excluded aneurysm. We report three patients who underwent successful endovascular AAA repair using the Excluder device (W. L. Gore & Associates, Flagstaff, Ariz). Although their postoperative surveillance showed an initial aneurysm regression, delayed aneurysm enlargement developed in all three, apparently due to endotension. Endovascular treatment was performed in which endograft reinforcement with a combination of aortic cuff and iliac endograft extenders were inserted in the previously implanted stent grafts. The endograft reinforcement procedure successfully resulted in aneurysm sac regression in all three patients. Our study underscores the significance of increased graft permeability as a mechanism of endotension and delayed aneurysm enlargement after successful endovascular AAA repair. In addition, our cases illustrate the feasibility and efficacy of an endovascular treatment strategy when endotension and aneurysm sac enlargement develops after endovascular AAA repair.
腹主动脉瘤（AAA）在成功进行血管内修复后会因内漏而扩大，内漏是指动脉瘤腔内持续的血流。在没有可检测到的内漏情况下，AAA仍可能扩大，部分原因是内张力，即被排除的动脉瘤内持续的压力。我们报告了3例使用Excluder装置（W.L. Gore & Associates，亚利桑那州弗拉格斯塔夫）成功进行血管内AAA修复的患者。尽管他们术后的监测显示最初动脉瘤缩小，但3例患者均出现了延迟性动脉瘤扩大，显然是由于内张力所致。进行了血管内治疗，在先前植入的支架移植物中插入了主动脉袖带和髂内移植物延长器相结合的方式对移植物进行强化。移植物强化手术成功地使所有3例患者的动脉瘤腔缩小。我们的研究强调了增加移植物通透性作为成功进行血管内AAA修复后内张力和延迟性动脉瘤扩大机制的重要性。此外，我们的病例说明了血管内AAA修复后出现内张力和动脉瘤腔扩大时血管内治疗策略的可行性和有效性。
