Bastos Gonçalves F, Verhagen H J M, Vasanthananthan K, Zandvoort H J A, Moll F L, van Herwaarden J A
Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands; Erasmus University Medical Center, Rotterdam, The Netherlands.
Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2014 Jul;48(1):53-9. doi: 10.1016/j.ejvs.2014.01.018. Epub 2014 Feb 26.
Direct additional therapy is advised for type-Ia endoleaks detected on completion angiography after endovascular aneurysm repair (EVAR). Additional intraoperative endovascular procedures are, however, often challenging or not possible, and direct open conversion is unattractive. The results of a selective, conservative strategy for patients with primary type-Ia endoleak has been analysed.
This was a retrospective, single-centre study (UMC, Utrecht, NL). From 2004 to 2008, all patients with a primary type-Ia endoleak and suitable anatomy for EVAR, stentgraft oversizing ≥15%, and optimal deployment were included. Complications during follow-up were studied and all sequential CTA scans were reviewed. These were compared with the remaining patients, treated during the same period.
Fifteen patients were included (14 male, median age 77, range 67-85) with a median aneurysm diameter of 60 mm (48-80), an aneurysm neck diameter of 26 mm (21-32), a neck length of 29 mm (11-39), and infrarenal angulation of 49° (31-90). One patient suffered rupture 2 days after EVAR - leading to the only AAA-related death. Eight of the 15 type-Ia endoleaks disappeared spontaneously on the first postoperative CTA, obtained within 1 week of EVAR. On the second postoperative CTA, obtained a median of 5 months (1-12) after EVAR, all remaining endoleaks had sealed. One recurrence occurred at 4.85 years. During a median follow-up of 3.3 years, there were five secondary interventions. Compared with controls, there were more secondary (or recurrent) type-1a endoleaks (13% vs. 4%), endograft migrations (13% vs. 3%), sac growths (33% vs. 16%), and secondary interventions (33% vs. 23%). None of these differences however, were statistically significant.
All but one of the primary type-Ia endoleaks sealed spontaneously. Until sealing, the risk of rupture persisted, but subsequently only one recurrence of type-Ia endoleak was seen. In selected patients, a conservative approach for primary type-Ia endoleaks may be justified.
对于血管内动脉瘤修复术（EVAR）术后造影检查发现的Ia型内漏，建议采用直接附加治疗。然而，额外的术中血管内操作往往具有挑战性或无法实施，且直接开放转换并不理想。本研究分析了针对原发性Ia型内漏患者的选择性保守策略的结果。
这是一项回顾性单中心研究（荷兰乌得勒支大学医学中心）。纳入2004年至2008年期间所有患有原发性Ia型内漏且解剖结构适合EVAR、支架移植物尺寸过大≥15%且部署最佳的患者。研究随访期间的并发症，并回顾所有连续的CTA扫描结果。将这些结果与同期接受治疗的其余患者进行比较。
纳入15例患者（14例男性，中位年龄77岁，范围67 - 85岁），中位动脉瘤直径60 mm（48 - 80），动脉瘤颈部直径26 mm（21 - 32），颈部长度29 mm（11 - 39），肾下角度49°（31 - 90）。1例患者在EVAR术后2天发生破裂，导致唯一1例与腹主动脉瘤相关的死亡。15例Ia型内漏中有8例在EVAR术后1周内进行的首次术后CTA检查时自发消失。在EVAR术后中位5个月（1 - 12）进行的第二次术后CTA检查时，所有剩余内漏均已封闭。1例在4.85年时复发。在中位3.3年的随访期间，有5次二次干预。与对照组相比，继发性（或复发性）Ia型内漏更多（13%对4%）、移植物移位更多（13%对3%）、瘤囊增大更多（33%对16%）以及二次干预更多（33%对23%）。然而，这些差异均无统计学意义。
除1例原发性Ia型内漏外，其余均自发封闭。在封闭之前，破裂风险持续存在，但随后仅观察到1例Ia型内漏复发。对于选定的患者，对原发性Ia型内漏采取保守方法可能是合理的。
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