Jones Steven M, Vallabhaneni S Rao, McWilliams Richard G, Naik Jagjeeth, Nicholas Tom, Fisher Robert K
1 Liverpool Vascular and Endovascular Service, Royal Liverpool Hospital, Liverpool, UK.
J Endovasc Ther. 2014 Oct;21(5):723-7. doi: 10.1583/13-4616MR.1.
To present confirmed cases of type IIIb endoleak in second and third-generation stent-grafts used for endovascular aneurysm repair (EVAR).
Four patients developed type IIIb endoleak caused by fabric tears between 4 and 13 years following their initial EVAR. Three patients presented with rupture and one with aneurysm expansion of unknown cause. In each case, the type IIIb endoleak was confirmed at open surgery after imaging proved non-diagnostic. Only one patient survived. Had the cause for the expansion or ruptures been found prior to open reintervention, relining of the stent-graft may have been possible.
Type IIIb endoleak remains difficult to diagnose. Avoidance of the high mortality associated with open secondary intervention requires a high degree of suspicion and it should be considered in any post-EVAR aneurysm expansion without an obvious cause.
介绍用于血管内动脉瘤修复术（EVAR）的第二代和第三代覆膜支架中IIIb型内漏的确诊病例。
4例患者在初次EVAR术后4至13年出现因覆膜撕裂导致的IIIb型内漏。3例患者出现破裂，1例患者出现原因不明的动脉瘤扩张。在每种情况下，影像学检查无法确诊，最终在开放手术中确诊为IIIb型内漏。仅1例患者存活。如果在开放再次干预之前发现扩张或破裂的原因，可能可以对覆膜支架进行内衬修复。
IIIb型内漏仍然难以诊断。避免与开放二次干预相关的高死亡率需要高度怀疑，对于任何无明显原因的EVAR术后动脉瘤扩张都应考虑到这一点。
