Piffaretti Gabriele, Franchin Marco, Botteri Emanuele, Boni Luigi, Carrafiello Gianpaolo, Battaglia Giuseppe, Bonardelli Stefano, Castelli Patrizio
Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Ann Vasc Surg. 2017 Feb;39:48-55. doi: 10.1016/j.avsg.2016.07.072. Epub 2016 Nov 24.
We report the results of the operative treatment for type 2 endoleak (T2E) involving the inferior mesenteric artery (IMA) using the transarterial embolization (TAE) or the video laparoscopic ligation (VLS).
Between January 2005 and December 2015, we retrospectively analyzed 901 patients treated with endovascular aortic repair (EVAR): 883 (98%) had 1 valid postoperative radiologic evaluation, at least. All patients with operative repair for IMA-related T2E entered the final analysis. Indication of their operative repair was sac enlargement (>5 mm within 6 months or >1 cm from the preoperative diameter, irrespectively of the postoperational time) and/or its persistence >12 months.
We detected 192 (21.7%) T2Es, overall. We identified 37 (4.2%) IMA-related T2Es, and treated 21 cases (VLS n = 11, TAE n = 10). Aneurysm-related mortality and major or minor morbidity was never observed. Time of intervention did not differ significantly (minutes, VLS = 97 ± 46 vs. TAE = 95 ± 21, P = 0.901). Hospitalization was significantly lower in the TAE group (days, 4 ± 2 vs. 1 ± 0.4, P < 0.001). No patient was lost at a mean follow-up of 46 ± 32 months (range, 1-110; median, 48). At last follow-up, sac diameter was significantly more stable in the VLS (mm, 60 ± 10 vs. 55 ± 7, P = 0.593) than that in the TAE group (mm, 57 ± 9 vs. 63 ± 10, P = 0.050). The IMA-related T2E reintervention rate was not significantly different between the groups (VLS, n = 0 [0%] vs. TAE, n = 2 [20.0%], P = 0.213). Secondary aortic reintervention rate was 28.6% (n = 6), and secondary open conversion rate was 9.5% (VLS, n = 1 [9.1%] vs. TAE, n = 1 [10.0%], P = 1).
In authors' experience, operative treatment of IMA-related T2E was safe; VLS proved to be effective and durable in sealing this type of T2E. Patients receiving correction of IMA-related T2E after EVAR remained at risk for development of any type of endoleaks, as well as at risk of reintervention.
我们报告了采用经动脉栓塞术（TAE）或电视腹腔镜结扎术（VLS）治疗涉及肠系膜下动脉（IMA）的2型内漏（T2E）的手术治疗结果。
2005年1月至2015年12月期间，我们回顾性分析了901例行血管腔内主动脉修复术（EVAR）的患者：883例（98%）至少有1次有效的术后影像学评估。所有接受与IMA相关的T2E手术修复的患者均纳入最终分析。其手术修复的指征为瘤体增大（6个月内增大>5mm或较术前直径增大>1cm，与术后时间无关）和/或持续时间>12个月。
总体上，我们共检测到192例（21.7%）T2E。我们识别出37例（4.2%）与IMA相关的T2E，并对21例进行了治疗（VLS组11例，TAE组10例）。未观察到与动脉瘤相关的死亡以及严重或轻微的并发症。干预时间无显著差异（分钟，VLS组=97±46，TAE组=95±21，P=0.901）。TAE组的住院时间显著更短（天，4±2比1±0.4，P<0.001）。平均随访46±32个月（范围1 - 110个月；中位数48个月）时无患者失访。在末次随访时，VLS组的瘤体直径比TAE组更稳定（毫米，60±10比55±7，P=0.593）（TAE组为57±9比63±10，P=0.050）。两组间与IMA相关的T2E再次干预率无显著差异（VLS组，n=0[0%]，TAE组，n=2[20.0%]，P=0.213）。二次主动脉再次干预率为28.6%（n=6），二次开放转换率为9.5%（VLS组，n=1[9.1%]，TAE组，n=1[10.0%]，P=1）。
根据作者的经验，与IMA相关的T2E的手术治疗是安全的；VLS在封闭此类T2E方面被证明是有效且持久的。接受EVAR术后与IMA相关的T2E矫正的患者仍有发生任何类型内漏的风险，以及再次干预的风险。
