Fujimura Naoki, Obara Hideaki, Matsubara Kentaro, Watada Susumu, Shibutani Shintaro, Akiyoshi Takurin, Harada Hirohisa, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine.
Circ J. 2016;80(1):118-23. doi: 10.1253/circj.CJ-15-0850. Epub 2015 Nov 13.
Clinically distinct differences exist between East Asian and Caucasian subjects, but data for type 2 endoleak (T2EL) are limited in the East Asian population. The aim of this study was to analyze the characteristics of East Asian T2EL using a Japanese multicenter database.
Retrospective analysis of 832 endovascular aneurysm repairs performed from 2008 to 2014 were conducted. T2EL was observed in 234 cases (28.1%), and in 32 cases (3.8%) it led to sac expansion >5 mm caused by isolated T2EL (median follow-up, 35.6 months). On univariate and multivariate analysis, non-smoker status (odds ratio [OR], 2.216; P<0.001), Excluder stent graft (OR, 2.027; P<0.001), and T2EL at final angiogram (OR, 2.080; P<0.001) were risk factors for T2EL. On multivariate analysis for isolated T2EL with sac expansion, only non-smoker status remained (OR, 2.671; P<0.001). Other than T1EL, isolated T2EL was the most significant risk factor for sac expansion (OR, 18.486; P<0.001). Furthermore, out of 11 transarterial embolization procedures initiated, 4 led to rupture during follow-up.
East Asian T2EL had a strong relationship with non-smoker status. Also, T2EL was a significant risk factor for sac expansion, which sometimes led to rupture even after intervention. Along with the high prevalence of T2EL observed, East Asian T2EL may not always be benign.
东亚人群与白种人在临床上存在明显差异,但关于东亚人群中2型内漏(T2EL)的数据有限。本研究旨在利用日本多中心数据库分析东亚T2EL的特征。
对2008年至2014年期间进行的832例血管内动脉瘤修复术进行回顾性分析。观察到234例(28.1%)发生T2EL,其中32例(3.8%)因孤立性T2EL导致瘤腔扩张>5 mm(中位随访时间35.6个月)。单因素和多因素分析显示,不吸烟状态(比值比[OR],2.216;P<0.001)、Excluder支架移植物(OR,2.027;P<0.001)以及最终血管造影时的T2EL(OR,2.080;P<0.001)是T2EL的危险因素。在对伴有瘤腔扩张的孤立性T2EL进行多因素分析时,仅不吸烟状态仍然是危险因素(OR,2.671;P<0.001)。除1型内漏(T1EL)外,孤立性T2EL是瘤腔扩张的最显著危险因素(OR,18.486;P<0.001)。此外,在启动的11例经动脉栓塞手术中,4例在随访期间发生破裂。
东亚T2EL与不吸烟状态密切相关。此外,T2EL是瘤腔扩张的重要危险因素,有时即使在干预后也会导致破裂。鉴于观察到的T2EL高发生率,东亚T2EL可能并非总是良性的。