Huang Dian, Zhou Min, Liu Changjian, Qiao Tong, Ran Feng
Department of Vascular and Endovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hosptial of Nanjing University Medical School, Nanjing Jiangsu, 210008, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Nov;27(11):1355-8.
To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak.
Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary.
Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement.
The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.
观察腹主动脉瘤（AAA）腔内修复术（EVAR）后内漏的发生情况，并分析内漏的相关因素。
2005年7月至2013年6月，210例AAA患者接受了EVAR治疗。210例患者中，男性175例，女性35例，年龄42 - 89岁（平均65.7岁）。所有患者均经计算机断层扫描血管造影（CTA）证实为肾下腹主动脉瘤。病程为1周 - 2年（中位数11.3周）。动脉瘤最大直径为44 - 72 mm（平均57.3 mm）。近端锚定区长度大于1.5 cm。术后2个月常规行CTA检查以检测造影剂内漏情况。若发现内漏，则在6个月时再次行CTA检查。若仍存在明显内漏，则行数字减影血管造影（DSA）以明确内漏的性质和程度，必要时行再次EVAR治疗。
术中发生内漏31例（14.8%），其中Ⅰ型内漏11例（ⅠA型8例，ⅠB型3例），Ⅱ型内漏18例，Ⅲ型内漏2例（ⅢB型）。患者随访2 - 8个月（平均3.1个月）。术后2个月，12例（5.7%）残余动脉瘤腔内发现造影剂内漏。术后6个月，CTA检查发现10例（4.8%）有造影剂内漏。8例行DSA检查的患者中，有Ⅰ型内漏4例（ⅠA型3例，ⅠB型1例），Ⅱ型内漏3例，Ⅲ型（ⅢB型）内漏1例。5例发生Ⅰ型和Ⅲ型内漏的患者观察到不同程度的支架移植物侧支移位；植入增加型支架移植物后，内漏在2 - 4个月后消失。发生Ⅱ型内漏的患者未给予特殊处理，CTA复查2个月时内漏仍存在，但AAA最大直径未增大。
支架移植物侧支移位是AAA患者EVAR术后发生Ⅰ型和Ⅲ型内漏的重要因素，再次EVAR可封堵内漏。
