Millen Alistair M, Osman Khabab, Antoniou George A, McWilliams Richard G, Brennan John A, Fisher Robert K
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom.
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom.
J Vasc Surg. 2015 May;61(5):1185-91. doi: 10.1016/j.jvs.2014.12.041. Epub 2015 Feb 2.
This study analyzed outcomes for patients with persistent intraoperative type Ia endoleaks after standard endovascular aneurysm repair (EVAR).
The study group was identified from a consecutive cohort of 209 patients undergoing EVAR in a tertiary center in the United Kingdom during a 2-year period. Data prospectively collected on departmental computerized databases were retrospectively analyzed. Primary outcome parameters were defined as freedom from type Ia endoleak, EVAR-related reintervention, aneurysm rupture, and aneurysm-related mortality.
A completion angiogram identified 44 patients (21%) as having a type Ia endoleak, and 33 (75%) had a persistent endoleak after intraoperative adjunctive procedures, including repeated balloon moulding, aortic cuff extension, and Palmaz stent (Cordis, Miami Lakes, Fla) deployment. In the 11 patients (25%) whose endoleak was successfully abolished intraoperatively, there was no recurrence of type Ia endoleak or secondary intervention to treat type 1a endoleak during a median follow-up period of 27 months. Of the 33 patients with persistent endoleak, 31 (94%) demonstrated resolution of the endoleak on first surveillance computed tomography angiography. One patient was lost to follow-up. Embolization of the endoleak in another patient was successful using Onyx (Micro Therapeutics, Inc, Irvine, Calif) 8 days after the initial procedure. No type Ia endoleak was identified after this on any surveillance imaging, and the patient was alive 28 months later with a stable aneurysm size. In the rest of the patients, no recurrence of the endoleak in any subsequent imaging was noticed, and no secondary intervention was required during follow-up. No aneurysm-related deaths occurred, and 91% of the patients had a stable or shrinking aneurysm.
Despite adjunctive intraoperative maneuvers, persistent type Ia endoleaks can be relatively common. Our study indicates that they may be observed in selected patients. Further research is required to investigate the natural course and management of type Ia endoleaks identified intraoperatively.
本研究分析了标准血管内动脉瘤修复术（EVAR）后持续性术中Ia型内漏患者的预后情况。
研究组来自英国一家三级中心在两年期间连续接受EVAR治疗的209例患者队列。对部门计算机数据库中前瞻性收集的数据进行回顾性分析。主要结局参数定义为无Ia型内漏、与EVAR相关的再次干预、动脉瘤破裂和动脉瘤相关死亡率。
造影检查发现44例患者（21%）存在Ia型内漏，33例（75%）在术中辅助操作（包括重复球囊塑形、主动脉袖带延长和Palmaz支架（Cordis，迈阿密湖，佛罗里达州）置入）后仍存在持续性内漏。在11例（25%）术中成功消除内漏的患者中，在中位随访期27个月内未出现Ia型内漏复发或治疗Ia型内漏的二次干预。在33例持续性内漏患者中，31例（94%）在首次监测计算机断层扫描血管造影时内漏消失。1例患者失访。另1例患者在初始手术后8天使用Onyx（Micro Therapeutics，Inc，尔湾，加利福尼亚州）成功栓塞内漏。此后在任何监测影像上均未发现Ia型内漏，该患者在28个月后存活，动脉瘤大小稳定。在其余患者中，后续任何影像检查均未发现内漏复发，随访期间无需二次干预。未发生与动脉瘤相关的死亡，91%的患者动脉瘤稳定或缩小。
尽管术中采取了辅助措施，但持续性Ia型内漏可能相对常见。我们的研究表明，在部分患者中可能会观察到这种情况。需要进一步研究来调查术中发现的Ia型内漏的自然病程和处理方法。
