Yamada Mitsutomo, Takahashi Hideki, Tauchi Yuya, Satoh Hisashi, Matsuda Hikaru
The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan.
Ann Vasc Dis. 2015;8(3):210-4. doi: 10.3400/avd.oa.14-00133. Epub 2015 Jun 26.
Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak.
Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment.
Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size.
We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.
血管腔内腹主动脉瘤修复术（EVAR）是一种越来越常用的腹主动脉瘤（AAA）修复方法。然而，持续性II型内漏的治疗仍是一个有争议的问题。本文报告5例因持续性II型内漏导致动脉瘤增大而行开放手术修复的病例。
回顾性分析2008年4月至2013年10月在我院接受手术的128例EVAR病例。这些病例在EVAR术后定期行增强CT检查。当持续性II型内漏导致动脉瘤囊增大时，我们采用手术修复作为一线治疗方法。手术中，经腹部正中小切口切开动脉瘤囊，从动脉瘤囊内缝合腰动脉，并结扎肠系膜下动脉（IMA），同时行动脉瘤修补术。开放修复术后1周行增强CT扫描以确认治疗是否彻底。
128例中有5例（3.9%）因动脉瘤囊增大（>5mm）需要手术修复，其中包括2例破裂性AAA病例。所有患者均顺利康复。这些手术后1周进行的增强CT扫描显示无内漏，支架移植物完好，动脉瘤尺寸缩小。
我们认为，对于因动脉瘤扩张导致的持续性II型内漏，开放手术修复方法是一种安全的方法，并且可以作为EVAR术后这种危及生命并发症的首选治疗方法之一。
