Baril Donald T, Silverberg Daniel, Ellozy Sharif H, Carroccio Alfio, Jacobs Tikva S, Sachdev Ulka, Teodorescu Victoria J, Lookstein Robert A, Marin Michael L
Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Ann Vasc Surg. 2008 Jan;22(1):30-6. doi: 10.1016/j.avsg.2007.10.003.
Despite high initial technical success, the long-term durability of endovascular abdominal aortic aneurysm repair (EVAR) continues to be a concern. Following EVAR, patients can experience endoleaks, device migration, device fractures, or aneurysm growth that may require intervention. The purpose of this study was to review all patients treated with secondary endovascular devices at our institution for failed EVAR procedures. Over an 8-year period, 988 patients underwent EVAR, of whom 42 (4.3%) required secondary interventions involving placement of additional endovascular devices. Data regarding patient characteristics, aneurysm size, initial device type, time until failure, failure etiology, secondary interventions, and outcomes were reviewed. The mean time from initial operation until second operation was 34.1 months. Failures included type I endoleaks in 38 patients (90.5%), type III endoleaks in two patients (4.8%), and enlarging aneurysms without definite endoleaks in two patients (4.8%). The overall technical success rate for secondary repair was 92.9% (39/42). Perioperative complications occurred in nine patients (21.4%), including wound complications (n = 6), cerebrovascular accident (CVA) (n = 1), foot drop (n = 1), and death (n = 1). Mean follow-up following secondary repair was 16.4 months (range 1-50). Eighty-six percent of patients treated with aortouni-iliac devices had successful repairs compared to 45% of patients treated with proximal cuffs. Ten patients (23.8%) had persistent or recurrent type I or type III endoleaks following revision. Of these, four had tertiary interventions, including two patients who had additional devices placed. Failures following EVAR occur in a small but significant number of patients. When anatomically possible, endovascular revision offers a safe means of treating these failures. Aortouni-iliac devices appear to offer a more durable repair than the proximal cuff for treatment of proximal type I endoleaks. Midterm results indicate that these patients may require additional procedures but have a low rate of aneurysm-related mortality. Longer-term follow-up is necessary to determine the durability of these endovascular revisions.
尽管血管内腹主动脉瘤修复术（EVAR）初期技术成功率较高，但其长期耐久性仍是一个令人担忧的问题。接受EVAR治疗后，患者可能会出现内漏、移植物移位、移植物骨折或动脉瘤增大，可能需要进行干预。本研究的目的是回顾我院所有因EVAR手术失败而接受二次血管内装置治疗的患者。在8年期间，988例患者接受了EVAR，其中42例（4.3%）需要进行二次干预，包括植入额外的血管内装置。回顾了患者特征、动脉瘤大小、初始装置类型、失败时间、失败病因、二次干预及结果等数据。从初次手术到二次手术的平均时间为34.1个月。失败原因包括38例（90.5%）I型内漏、2例（4.8%）III型内漏以及2例（4.8%）无明确内漏的动脉瘤增大。二次修复的总体技术成功率为92.9%（39/42）。9例（21.4%）患者出现围手术期并发症，包括伤口并发症（n = 6）、脑血管意外（CVA）（n = 1）、足下垂（n = 1）和死亡（n = 1）。二次修复后的平均随访时间为16.4个月（范围1 - 50个月）。接受主动脉单髂动脉装置治疗的患者中86%修复成功，而接受近端袖带治疗的患者中这一比例为45%。10例（23.8%）患者在翻修后仍有持续性或复发性I型或III型内漏。其中，4例接受了三次干预，包括2例植入了额外装置的患者。EVAR术后失败发生在少数但数量可观的患者中。在解剖结构允许的情况下，血管内翻修术为治疗这些失败提供了一种安全的方法。对于治疗近端I型内漏，主动脉单髂动脉装置似乎比近端袖带提供更持久的修复。中期结果表明，这些患者可能需要额外的手术，但动脉瘤相关死亡率较低。需要更长时间的随访来确定这些血管内翻修术的耐久性。
