Tsilimparis N, Laipple A, Yousefi S, Alevizakos P, Spring B Im, Rogalla P, Hagemann J, Hanack U, Rückert R I
Chirurgische Klinik, Franziskus-Krankenhaus Berlin.
Zentralbl Chir. 2009 Aug;134(4):331-7. doi: 10.1055/s-0028-1098771. Epub 2009 Aug 17.
Redo surgery or reintervention following conventional or endovascular aortoiliac reconstruction often requires exclusion of new aneurysms. In the present study the potentials of endovascular management of such lesions are investigated.
All patients with endovascular reoperation for of newly developed aortoiliac aneurysms were identified from a prospectively run data-base. The indications and results of endovascular therapy were analysed retrospectively. In detail, data were analysed for the type of original operation, interval until and kind of reoperation, and results concerning survival, technical success and complications.
From 12 / 2003 through 3 / 2007 195 patients with aortoiliac aneurysms were operated. Endovascular repair was performed in 15 cases of previously excluded aneurysms. Mean age of these 15 patients (12 men) was 73 (64-85) years. Ten patients had a primary conventional (group A) and 5 patients had a primary endovascular (group B) aneurysm repair. The mean time interval between the first and second operation was 8.9 (1-26) years. The secondary endovascular therapy in group A was successful in all cases. In group B endoleaks type I a (n = 1), I a / b (n = 1), II (n = 2) and III (n = 1) were treated. One type II endoleak could only be treated successfully by conversion to open repair, the other one was successfully treated by reintervention. All but one patient are alive and -remained free of pathological findings during a median follow-up of 13 (2-39) months.
Because of the clearly elevated operation risk of redo surgery after conventional or endovascular aneurysm repair, endovascular aneurysm exclusion represents the method of first choice. The reasonable selection and combination of procedures allows for an optimal adaptation of therapy to the individual case.
在传统或血管腔内腹主动脉-髂动脉重建术后进行再次手术或再次干预时，通常需要排除新出现的动脉瘤。在本研究中，对这类病变进行血管腔内治疗的潜力进行了研究。
从一个前瞻性运行的数据库中识别出所有因新出现的腹主动脉-髂动脉动脉瘤而接受血管腔内再次手术的患者。对血管腔内治疗的适应证和结果进行回顾性分析。详细分析了原始手术类型、再次手术的间隔时间和类型，以及生存、技术成功和并发症方面的结果。
从2003年12月至2007年3月，195例腹主动脉-髂动脉动脉瘤患者接受了手术。15例先前已排除的动脉瘤患者接受了血管腔内修复。这15例患者（12例男性）的平均年龄为73岁（64 - 85岁）。10例患者最初接受了传统手术（A组），5例患者最初接受了血管腔内动脉瘤修复（B组）。首次手术与第二次手术之间的平均时间间隔为8.9年（1 - 26年）。A组的二次血管腔内治疗全部成功。B组中，对Ⅰa型（n = 1）、Ⅰa/b型（n = 1）、Ⅱ型（n = 2）和Ⅲ型（n = 1）内漏进行了治疗。1例Ⅱ型内漏只能通过转为开放修复成功治疗，另1例通过再次干预成功治疗。除1例患者外，所有患者在中位随访13个月（2 - 39个月）期间均存活且无病理发现。
由于传统或血管腔内动脉瘤修复术后再次手术的手术风险明显升高，血管腔内动脉瘤排除是首选方法。合理选择和联合手术方法可使治疗方案最佳地适应个体情况。
