Biancari F, Mäkelä J, Juvonen T, Venermo M
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Eur J Vasc Endovasc Surg. 2015 Nov;50(5):671-4. doi: 10.1016/j.ejvs.2015.06.116. Epub 2015 Aug 28.
Type II endoleak is a common condition occurring after endovascular repair of abdominal aortic aneurysms (EVAR), and may result in aneurysm sac growth and/or rupture in a small number of patients. A prophylactic strategy of inferior mesenteric artery (IMA) embolization before EVAR has been advocated, however, the benefits of this strategy are controversial. A clinical vignette allows the authors to summarize the available data about this issue and discuss the possible benefits and risks of prophylactic IMA embolization before EVAR. The authors performed a meta-analysis of available data which showed that the pooled rate of type II endoleak after IMA embolization was 19.9% (95% CI 3.4-34.7%, I2 93%) whereas it was 41.4% (95% CI 30.4-52.3%, I2 76%) in patients without IMA embolization (5 studies including 596 patients: p < .0001, OR 0.369, 95% CI 0.22-0.61, I2 27%). Since treatment for type II endoleaks is needed in less than 20% of cases and this complication can be treated successfully in 60-70% of cases resulting in an aneurysm rupture risk of 0.9%, these data indicate that embolization of patent IMA may be of no benefit in patients undergoing EVAR.
II型内漏是腹主动脉瘤血管内修复术（EVAR）后常见的情况，少数患者可能会出现瘤体增大和/或破裂。有人主张在EVAR前采用预防性肠系膜下动脉（IMA）栓塞策略，然而，该策略的益处存在争议。一个临床案例让作者能够总结关于这个问题的现有数据，并讨论EVAR前预防性IMA栓塞可能的益处和风险。作者对现有数据进行了荟萃分析，结果显示IMA栓塞后II型内漏的合并发生率为19.9%（95%CI 3.4 - 34.7%，I² 93%），而未进行IMA栓塞的患者中这一发生率为41.4%（95%CI 30.4 - 52.3%，I² 76%）（5项研究，共596例患者：p <.0001，OR 0.369，95%CI 0.22 - 0.61，I² 27%）。由于不到20%的病例需要治疗II型内漏，且60 - 70%的病例可以成功治疗这种并发症，导致动脉瘤破裂的风险为0.9%，这些数据表明，对于接受EVAR的患者，栓塞通畅的IMA可能没有益处。
