Toya Naoki, Fujita Tetsuji, Kanaoka Yuji, Ohki Takao
Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Vasc Med. 2008 Nov;13(4):305-11. doi: 10.1177/1358863X08094850.
Endovascular aneurysm repair (EVAR) is a new and minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Soon after its introduction in 1990, it was recognized that EVAR had potential and distinct advantages in the elective and emergency settings. However, long-term follow-up has shown enlargement of the AAA in a substantial percentage of patients who underwent EVAR with the original-permeability Excluder. Of interest is that sac expansion frequently occurs in the absence of endoleak, often referred to as endotension. The pathophysiology of endoleak is beginning to be elucidated and its management is ready to be established, while controversy still exists about the etiology and clinical consequences of endotension. Fortunately, the incidence of endotension is decreasing and it appears that AAA expansion after EVAR with the original Excluder can be arrested by endovascular relining with a low-permeability Excluder endoprosthesis. The aim of this brief review is to provide historical perspective and a good understanding of the etiology, diagnosis, and management of endotension.
血管内动脉瘤修复术（EVAR）是腹主动脉瘤（AAA）患者开放性修复术的一种新型微创替代方法。1990年引入后不久，人们就认识到EVAR在择期和急诊情况下具有潜在的明显优势。然而，长期随访显示，在接受原始通透性Excluder进行EVAR治疗的相当一部分患者中，AAA出现了增大。有趣的是，瘤腔扩张经常在无内漏的情况下发生，通常称为内张力。内漏的病理生理学开始得到阐明，其处理方法也即将确立，而关于内张力的病因和临床后果仍存在争议。幸运的是，内张力的发生率正在下降，并且似乎使用低通透性Excluder血管内支架进行血管腔内衬里可以阻止使用原始Excluder进行EVAR术后的AAA扩张。本简要综述的目的是提供历史视角，并深入了解内张力的病因、诊断和处理。
