Chughtai Haroon L, Janjua Muhammad, Patel Kirit
Department of Cardiology, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA.
J Invasive Cardiol. 2011 Aug;23(8):E188-91.
One of the most common complications of endovascular aneurysm repair (EVAR) is type 2 endoleak. We describe a patient who presented with a recurrent endoleak despite initial intervention and was successfully treated with coil embolization of the inferior mesenteric artery (IMA).
A 63-year-old Caucasian male was found to have a 7.5 cm abdominal aortic aneurysm (AAA) during a routine ultrasound of the kidneys. The patient successfully underwent EVAR with exclusion of the aneurysm sac. A computed tomographic (CT) scan was performed 30 days after the procedure, and showed presence of a large type 1a endoleak with slight enlargement of the sac. The endoleak was successfully repaired with 2 extension cuffs which resulted in resolution of the endoleak. A few months later, another CT scan was performed that showed a type 2 endoleak without enlargement of the sac; however, there was no reduction in the size of the sac. Multiplanar reconstruction was used and a small branch connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) through the marginal artery was found. A selective angiogram of the SMA was performed that showed filling of the aneurysm sac. A microcatheter was advanced through the SMA and marginal artery into the IMA. The IMA was occluded with coil embolization, resulting in resolution of the endoleak.
Our case describes a patient who initially underwent treatment for type 1a endoleak and subsequently developed type 2 endoleak that was successfully treated with coil embolization of the IMA.
血管内动脉瘤修复术（EVAR）最常见的并发症之一是2型内漏。我们描述了一名患者，尽管最初进行了干预，但仍出现复发性内漏，最终通过肠系膜下动脉（IMA）线圈栓塞术成功治疗。
一名63岁的白种男性在肾脏常规超声检查中发现有一个7.5厘米的腹主动脉瘤（AAA）。患者成功接受了EVAR，动脉瘤囊被排除。术后30天进行了计算机断层扫描（CT），显示存在一个大型1a型内漏，囊略有增大。通过2个延长袖带成功修复了内漏，内漏得以解决。几个月后，再次进行CT扫描，显示有一个2型内漏，囊没有增大；然而，囊的大小没有缩小。采用多平面重建，发现一条通过边缘动脉将肠系膜上动脉（SMA）与肠系膜下动脉（IMA）相连的小分支。对SMA进行了选择性血管造影，显示动脉瘤囊有造影剂充盈。将微导管通过SMA和边缘动脉推进到IMA。通过线圈栓塞术闭塞了IMA，内漏得以解决。
我们的病例描述了一名患者，最初接受了1a型内漏的治疗，随后出现了2型内漏，并通过IMA线圈栓塞术成功治疗。
