Phan Dinh Dong Nghi, Meyer Frank, Pech Maciej, Halloul Zuhir
Division of Vascular Surgery, Department of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Department of Radiology and Nuclear Medicine, University Hospital at Magdeburg, Magdeburg, Germany.
Wien Klin Wochenschr. 2015 Nov;127(21-22):851-857. doi: 10.1007/s00508-015-0871-y. Epub 2015 Nov 5.
To evaluate the predicting factors for the development of endoleak type II, its frequency and influencing factors after elective endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA).
Data were prospectively collected in a unicenter observational study (tertiary center of [endo-] vascular surgery) and retrospectively evaluated in patients who had undergone elective EVAR of AAA. Vascular (lumbar arteries (LA) and inferior mesenteric artery, aneurysm) and general patient (habits, medication, basic diseases) as well as procedural characteristics, were analyzed for their association with the development of endoleak type II. Pre and postinterventional computed tomography (CT) scans were evaluated for aneurysm anatomy, in particular, postinterventional growth or shrinkage as well detection of an endoleak of each type.
The study cohort included 82 patients (mean age, 72 (52-87) years; 77 men, 93.9%) throughout 36 months. The median follow-up period was 29.5 months (range, 1-57). Overall, 51 endoleaks type II (62.2%) were identified at any time during the postinterventional follow-up period. In the Cox regression, AAA length was the only significant predictor (P = 0.024; hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14). Thirteen patients (15.8%) underwent at least one secondary intervention. Aneurysm growth was observed in four patients because of an endoleak type II (4.9%). No AAA rupture occurred in association with an isolated endoleak type II.
The preoperative AAA length (correlating with the number of LA) can be considered a risk factor for postinterventional occurrence of endoleak type II prompting to greater attention and possible preemptive therapy.
评估肾下腹主动脉瘤（AAA）择期血管腔内修复术（EVAR）后II型内漏发生的预测因素、其发生率及影响因素。
在一项单中心观察性研究（[血管]外科三级中心）中前瞻性收集数据，并对接受AAA择期EVAR的患者进行回顾性评估。分析血管因素（腰动脉（LA）和肠系膜下动脉、动脉瘤）、一般患者因素（习惯、用药、基础疾病）以及手术特征与II型内漏发生的相关性。对介入前后的计算机断层扫描（CT）进行评估，以了解动脉瘤解剖结构，特别是介入后动脉瘤的生长或缩小情况以及各类型内漏的检测情况。
在36个月期间，研究队列包括82例患者（平均年龄72（52 - 87）岁；77例男性，占93.9%）。中位随访期为29.5个月（范围1 - 57个月）。总体而言，在介入后随访期间的任何时间共发现51例II型内漏（62.2%）。在Cox回归分析中，AAA长度是唯一显著的预测因素（P = 0.024；风险比（HR），1.07；95%置信区间（CI），1.01 - 1.14）。13例患者（15.8%）至少接受了一次二次干预。4例患者因II型内漏出现动脉瘤生长（4.9%）。未发生与孤立性II型内漏相关的AAA破裂。
术前AAA长度（与LA数量相关）可被视为介入后发生II型内漏的危险因素，需引起更多关注并可能进行预防性治疗。
