Cleveland Clinic-Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
J Vasc Surg. 2012 Jan;55(1):33-40. doi: 10.1016/j.jvs.2011.07.092. Epub 2011 Nov 3.
Aneurysm growth after endovascular aneurysm repair (EVAR) in patients with type II endoleak is associated with adverse outcomes. This study evaluated the long-term success of embolization of type II endoleaks in preventing aneurysm sac growth.
We retrospectively reviewed outcomes of patients who underwent infrarenal EVAR who were treated for a type II endoleak between 2000 and 2008. Computed tomography scans were evaluated for aneurysm sac growth or shrinkage from the time of treatment of the endoleak. The embolization material used, graft type, target vessel embolized, and comorbidities were evaluated for their association with sac growth or shrinkage.
Ninety-five patients underwent 140 embolization procedures. The mean time from EVAR to embolization was 26.1 ± 22.2 months, and the average increase in size of the aneurysm sac from EVAR to treatment was 0.7 × 0.5 cm. Patients underwent an average of 1.6 ± 0.8 embolization procedures after EVAR. Thirteen patients underwent initial simultaneous embolization of two targets. Embolization was with glue (61%), coils (29%), glue and coils (7%), and Gelfoam (3%; Pfizer Inc, New York, NY). No abdominal aortic aneurysms (AAA) ruptured. Eight patients (8.4%) underwent graft explant and open repair; 19 (20%) required two or more embolization procedures. There was no difference in the target vessel treated or the treatment used in halting sac expansion (>5 mm). Coil embolization alone resulted in more second procedures. The 5-year cumulative survival was 65% (95% confidence interval [CI], 52%-77%), freedom from explant was 89% (95% CI, 81%-97%), freedom from second embolization was 76% (95% CI, 66%-86%), and freedom from sac expansion >5 mm was 44% (95% CI 30%-50%). Univariable analysis identified continued tobacco use (hazard ratio [HR], 2.30; 95% CI, 1.02-5.13; P = .04) was associated with continued sac expansion, and hyperlipidemia (HR, 9.64; 95% CI, 2.22-41.86) was associated with patients requiring a second embolization procedure.
Embolization of type II endoleaks is successful early in preventing aneurysm sac growth and rupture after EVAR. However, a significant number of patients require more than one procedure, and at 5 years, many patients who underwent embolization of a type II endoleak continued to experience sac growth. Patients with hyperlipidemia who undergo coil embolization are more likely to require a second embolization procedure, and patients who smoke have a higher likelihood of AAA sac expansion after embolization. Continued long-term surveillance is necessary in this cohort of patients.
血管内动脉瘤修复（EVAR）后 II 型内漏导致的动脉瘤生长与不良结局相关。本研究评估了 II 型内漏栓塞术在预防动脉瘤囊生长方面的长期效果。
我们回顾性分析了 2000 年至 2008 年间接受腹主动脉下段 EVAR 治疗的 II 型内漏患者的治疗结果。从内漏治疗开始，通过计算机断层扫描评估动脉瘤囊的生长或缩小情况。评估使用的栓塞材料、移植物类型、栓塞的靶血管以及并存疾病与囊生长或缩小的关系。
95 例患者共进行了 140 次栓塞治疗。EVAR 至栓塞治疗的平均时间为 26.1 ± 22.2 个月，EVAR 至治疗时动脉瘤囊的平均增大尺寸为 0.7×0.5cm。患者在 EVAR 后平均进行 1.6±0.8 次栓塞治疗。13 例患者同时栓塞了两个目标。栓塞材料包括胶（61%）、弹簧圈（29%）、胶和弹簧圈（7%）和明胶海绵（3%，辉瑞公司，纽约，NY）。无腹主动脉瘤（AAA）破裂。8 例（8.4%）患者行移植物取出和开放修复；19 例（20%）需要进行两次或以上的栓塞治疗。在停止囊扩张（>5mm）方面，处理的靶血管或使用的治疗方法没有差异。单纯弹簧圈栓塞导致更多的二次治疗。5 年累积生存率为 65%（95%置信区间，52%-77%），移植物取出率为 89%（95%置信区间，81%-97%），二次栓塞率为 76%（95%置信区间，66%-86%），囊扩张>5mm 的比例为 44%（95%置信区间，30%-50%）。单变量分析发现，持续吸烟（风险比[HR]，2.30；95%置信区间，1.02-5.13；P=0.04）与持续囊扩张相关，而高脂血症（HR，9.64；95%置信区间，2.22-41.86）与需要二次栓塞治疗的患者相关。
在 EVAR 后早期，栓塞 II 型内漏可成功预防动脉瘤囊生长和破裂。然而，仍有相当数量的患者需要进行多次治疗，在 5 年时，许多接受 II 型内漏栓塞治疗的患者仍继续出现囊生长。接受弹簧圈栓塞治疗且伴有高脂血症的患者更有可能需要进行二次栓塞治疗，而吸烟的患者在栓塞后 AAA 囊扩张的可能性更高。该队列的患者需要持续进行长期监测。
