Schlösser F J V, Gusberg R J, Dardik A, Lin P H, Verhagen H J M, Moll F L, Muhs B E
Section of Vascular Surgery, Yale University, New Haven, CT 06510, United States.
Eur J Vasc Endovasc Surg. 2009 Jan;37(1):15-22. doi: 10.1016/j.ejvs.2008.10.011. Epub 2008 Nov 12.
To provide insight into the causes and timing of AAA rupture after EVAR.
Original data regarding AAA ruptures following EVAR were collected from MEDLINE and EMBASE databases. Data were extracted systematically and patient and procedural characteristics were analyzed.
270 patients with AAA ruptures after EVAR were identified. Causes of rupture included endoleaks (in 160: type IA 57, type IB 31, type II 23, type III 26, type IV 0, endotension 9, unspecified 14), graft migration 41, graft disconnection 11 and infection 6. Most of the described AAA ruptures occurred within 2-3 years after EVAR. Mean initial AAA diameter was relatively large (65 mm). No abnormalities were present in 41 patients during follow-up before rupture. Structural graft failure was described in 96 and a fatal course in 119 patients.
Focus of surveillance on the first 2-3 years after EVAR may possibly reduce the AAA rupture rate, especially in patients with increased risk of early rupture (relatively large initial AAA diameter or presence of endoleak or graft migration). Better stent-graft durability and longevity is required to further reduce the AAA rupture risk after EVAR. Complete prevention will however remain challenging since AAA rupture may occur even if no predisposing abnormalities are present.
深入了解腔内修复术后腹主动脉瘤（AAA）破裂的原因及时间。
从MEDLINE和EMBASE数据库收集腔内修复术后AAA破裂的原始数据。系统提取数据并分析患者及手术特征。
共识别出270例腔内修复术后AAA破裂患者。破裂原因包括内漏（160例：IA型57例、IB型31例、II型23例、III型26例、IV型0例、内张力9例、未明确类型14例）、移植物移位41例、移植物断开11例和感染6例。大多数所述AAA破裂发生在腔内修复术后2至3年内。初始AAA平均直径相对较大（65毫米）。41例患者在破裂前的随访期间未发现异常。96例描述为结构性移植物失败，119例患者病程致命。
腔内修复术后前2至3年的监测重点可能会降低AAA破裂率，尤其是对于早期破裂风险增加的患者（初始AAA直径相对较大或存在内漏或移植物移位）。需要提高支架移植物的耐用性和使用寿命，以进一步降低腔内修复术后AAA破裂风险。然而，完全预防仍具有挑战性，因为即使不存在易患异常，AAA仍可能破裂。
