Division of Vascular Surgery and Endovascular Therapy, Loyola University, Stritch School of Medicine, Maywood, Ill, USA.
J Vasc Surg. 2011 Feb;53(2):534-9. doi: 10.1016/j.jvs.2010.11.130.
Few would argue with the need for long-term follow-up after endovascular repair of abdominal aortic aneurysms. A small risk of reintervention persists and the challenge remains to identify those patients that will require additional procedures to prevent subsequent complications. The ideal follow-up regimen remains elusive. Up until this point, most regimens have consisted of radiologic imaging, with either computed tomography (CT) scans or ultrasonography to identify continued aneurysm perfusion (endoleaks) and document sac dynamics, either shrinkage, growth, or stability. However, aneurysm sac growth or shrinkage serves only as a surrogate measurement for pressurization, and although it is uniformly believed that attachment site endoleaks require treatment, it remains controversial as to how to determine which type II endoleaks pressurize an aneurysm sufficiently to require therapy. In response to these difficulties, several manufacturers have developed pressure sensors that can be implanted at the time of the initial repair. They have been shown capable of measuring intrasac pressures that have appropriately responded to reinterventions for endoleaks. However, are they the answer we are looking for? Are they ready for widespread use? Do they offer a reliable and consistent measure of intrasac pressure that can be trusted to determine the need, or lack of need, for further therapy? Our debaters will try to convince us one way or another.
很少有人会质疑血管内修复腹主动脉瘤后进行长期随访的必要性。再次介入治疗的风险仍然存在，挑战仍然是识别那些需要额外手术以预防后续并发症的患者。理想的随访方案仍然难以捉摸。到目前为止，大多数方案都包括放射影像学检查，无论是计算机断层扫描 (CT) 扫描还是超声检查，以识别持续的动脉瘤灌注（内漏）并记录囊腔动力学，无论是缩小、增长还是稳定。然而，动脉瘤囊的生长或缩小仅作为压力的替代测量指标，尽管普遍认为附着部位内漏需要治疗，但如何确定哪种 II 型内漏足以使动脉瘤加压需要治疗仍然存在争议。为了应对这些困难，几家制造商已经开发出可以在初次修复时植入的压力传感器。它们已被证明能够测量适当响应内漏再介入治疗的囊内压力。然而，它们是我们正在寻找的答案吗？它们是否准备好广泛使用？它们是否提供了一种可靠且一致的囊内压力测量方法，可以用于确定是否需要进一步治疗？我们的辩论者将试图以某种方式说服我们。
