Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.
J Endovasc Ther. 2011 Oct;18(5):686-96. doi: 10.1583/11-3541.1.
To test whether combining embolization with endothelial denudation could reduce endoleak persistence and recurrence after endovascular aneurysm repair (EVAR) in an animal model.
Type I endoleaks with collateral outflow were created in bilateral iliac aneurysms in 12 dogs. In 6 animals (group 1), endoleaks were treated by thrombin injection, with or without mechanical denudation of the endothelium. In the other 6 animals (group 2), simultaneous occlusion and endothelial denudation was induced in one side by treatment with a gel containing ethanol, ethylcellulose, and lipiodol, whereas the other side was treated with saline control. Follow-up ultrasonography and angiography were performed before necropsy and histology at 3 months.
Denudation combined with thrombin injection led to higher aneurysm shrinkage than thrombin alone, as shown by the mean relative aneurysm diameter (89% vs. 124% at baseline, p<0.01) and length (61% vs. 82% at baseline, p<0.01). Denudation did not significantly reduce endoleak occurrence (4/6 vs. 6/6); however, endoleaks in denuded aneurysms were significantly smaller and located in areas inaccessible to denudation. Six of the 10 endoleaks seen at 3 months occurred despite complete initial occlusion (recurrent endoleaks). In the gel-treated group, embolized aneurysms did not shrink significantly, and stent-graft thrombosis developed in 3/6 embolized aneurysms; however, the 3 other aneurysms showed no endoleaks, while all 6 saline-treated controls exhibited persistent endoleaks.
This study demonstrates the role of recanalization in endoleak recurrence and indicates that combining embolization and endothelial denudation could be a promising strategy to prevent endoleak persistence or recurrence after EVAR. However, the sclerosing gel tested in this study is not appropriate since it is prone to migration with resultant stent-graft thrombosis.
在动物模型中检验血管内动脉瘤修复术（EVAR）后联合血管内栓塞和血管内皮剥脱术是否能降低内漏持续和复发的情况。
在 12 只狗的双侧髂动脉瘤中建立 I 型内漏伴侧支流出。在 6 只动物（第 1 组）中，用凝血酶注射，或同时进行机械性内皮剥脱术治疗内漏。在另 6 只动物（第 2 组）中，一侧通过应用含有乙醇、乙基纤维素和碘油的凝胶来诱导同时闭塞和内皮剥脱，而另一侧用生理盐水作为对照进行处理。在尸检前进行超声检查和血管造影检查，并在 3 个月时进行组织学检查。
与单独使用凝血酶相比，剥脱联合凝血酶注射导致动脉瘤收缩程度更高，平均相对动脉瘤直径（与基线相比分别为 89%和 124%，p<0.01）和长度（与基线相比分别为 61%和 82%，p<0.01）。剥脱并不能显著降低内漏的发生（4/6 比 6/6）；然而，剥脱后的动脉瘤内漏明显更小，并且位于无法进行剥脱的区域。尽管最初完全闭塞，但在 3 个月时，10 个内漏中有 6 个再次出现（复发性内漏）。在凝胶处理组中，栓塞的动脉瘤没有明显收缩，6 个栓塞的动脉瘤中有 3 个发生支架内血栓形成；然而，另外 3 个动脉瘤没有内漏，而所有 6 个生理盐水处理的对照组都有持续的内漏。
本研究证明了再通在内漏复发中的作用，并表明联合栓塞和血管内皮剥脱术可能是预防 EVAR 后内漏持续或复发的一种有前途的策略。然而，本研究中测试的硬化凝胶不太合适，因为它容易迁移并导致支架内血栓形成。
