Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
J Endovasc Ther. 2011 Oct;18(5):676-82. doi: 10.1583/11-3432.1.
To determine the risk of aneurysm rupture in patients with persisting proximal type Ia endoleaks following endovascular aneurysm repair (EVAR) in comparison to the risk of rupture of untreated abdominal aortic aneurysms (AAA) of similar size.
Among 400 patients who where treated with EVAR from 1996 to 2003 at a single center, 21 (5.3%) patients (13 men; mean age 78.0±5.0 years, range 67-86) with large (≥5.5 cm) aneurysms had imaging evidence of type Ia endoleaks that persisted >10 months (type Ia group) despite secondary endovascular treatment. These patients were compared to 24 untreated AAA patients (17 men; mean age 73.8±5.2 years, range 64-88) with large aneurysms from a separate geographic region with a well-established aneurysm treatment program before EVAR became available (1990-1998).
There were no significant differences between the type Ia and the untreated AAA patients with regard to age (79±8 vs. 74±5 years), gender (38% vs. 29% women), baseline aneurysm diameter (6.1±0.7 vs. 6.4±0.9 cm), or length of follow-up (32±23 vs. 29±40 months). During the follow-up period, the rate of aneurysm enlargement was significantly lower in type Ia patients (0.19 cm/y) than in untreated AAA patients (0.54 cm/y, p = 0.03). One (4.8%) patient with a persisting type Ia endoleak and 2-cm aneurysm enlargement (0.8 cm/y) had aneurysm rupture after 2.5 years, while 12 (50%) of the 24 untreated aneurysms ruptured (p = 0.001), which was the primary cause of death in this group. The rupture rate was 1.8 per 100 patient-years in the type Ia group and 20.7 per 100 patient-years in the untreated AAA group. Aneurysm-related mortality was significantly reduced in the type Ia group compared to the untreated AAA group at 36 months (11% vs. 52%, p = 0.004). In the multivariate analysis, factors associated with death were an untreated AAA (odds ratio 97, p = 0.004), female gender (odds ratio 9.7, p = 0.02), and baseline aneurysm size (odds ratio 4.7/cm, p = 0.03).
This study suggests that EVAR may reduce the risk of rupture and aneurysm-related death despite the presence of a persisting type Ia endoleak. This finding is limited to patients with aortic endografts that are in good position. The mechanism of protection from rupture is unclear but may be related to reducing the rate of aneurysm enlargement.
比较血管内修复术（EVAR）后持续存在近端 I 型内漏的患者与相似大小未治疗的腹主动脉瘤（AAA）破裂的风险，以确定动脉瘤破裂的风险。
在一个中心，对 1996 年至 2003 年期间接受 EVAR 治疗的 400 名患者进行了研究，21 名（5.3%）男性（平均年龄 78.0±5.0 岁，范围 67-86）患者（13 名），大（≥5.5cm）动脉瘤存在影像学证据表明存在 I 型内漏，尽管进行了二次血管内治疗，但仍持续存在>10 个月（I 型组）。这些患者与 24 名来自另一个地理区域的未治疗的 AAA 患者（17 名男性；平均年龄 73.8±5.2 岁，范围 64-88）进行了比较，这些患者在 EVAR 之前已经有了一个成熟的动脉瘤治疗方案（1990-1998）。
在年龄（79±8 岁 vs. 74±5 岁）、性别（38% vs. 29%女性）、基线动脉瘤直径（6.1±0.7cm vs. 6.4±0.9cm）或随访时间（32±23 个月 vs. 29±40 个月）方面，I 型和未治疗的 AAA 患者之间没有显著差异。在随访期间，I 型患者的动脉瘤增大速度明显低于未治疗的 AAA 患者（0.19cm/y vs. 0.54cm/y，p=0.03）。1 名（4.8%）持续存在 I 型内漏且动脉瘤增大 2cm（0.8cm/y）的患者在 2.5 年后发生了动脉瘤破裂，而 24 名未治疗的动脉瘤中有 12 名（50%）发生了破裂（p=0.001），这是该组患者死亡的主要原因。I 型组的破裂率为每 100 名患者 1.8 例，未治疗的 AAA 组为每 100 名患者 20.7 例。在 36 个月时，I 型组的动脉瘤相关性死亡率明显低于未治疗的 AAA 组（11% vs. 52%，p=0.004）。在多变量分析中，与死亡相关的因素是未治疗的 AAA（优势比 97，p=0.004）、女性（优势比 9.7，p=0.02）和基线动脉瘤大小（优势比 4.7/cm，p=0.03）。
这项研究表明，尽管存在持续存在的 I 型内漏，EVAR 仍可能降低破裂和动脉瘤相关死亡的风险。这一发现仅限于位置良好的主动脉内支架的患者。保护免受破裂的机制尚不清楚，但可能与减少动脉瘤增大的速度有关。
