Division of Vascular Surgery, The Jikei University Kashiwa Hospital.
Department of Surgery, The Jikei University Kashiwa Hospital.
Circ J. 2018 Jan 25;82(2):340-345. doi: 10.1253/circj.CJ-17-0786. Epub 2017 Sep 27.
Aneurysm expansion, and consequent endoleaks, after endovascular aneurysm repair (EVAR) is a major problem. Accurate prediction of aneurysm expansion is demanding for surgeons and remains difficult.Methods and Results:We retrospectively analyzed 157 cases of EVAR for abdominal aortic aneurysm (AAA) using a bifurcated main-body stent-graft. There were 62 cases of aneurysm shrinkage after EVAR, 63 cases of stable aneurysm, and 32 cases of aneurysm expansion. Type I endoleaks were significantly increased in the aneurysm expansion group (EXP) compared with the stable (STB) and shrinkage (SHR) groups (EXP: 15.6% vs. STB: 4.8% vs. SHR: 0%, P=0.005). Type II endoleaks were also significantly increased in EXP (EXP: 65.6% vs. STB: 36.5% vs. SHR: 6.5%, P<0.001). Aneurysm wall enhancement (AWE) on imaging, however, was significantly decreased in the EXP group (EXP: 18.8% vs. STB: 23.8% vs. SHR: 53.2%, P<0.001). In multivariate analysis, the occurrence of type II endoleaks significantly decreased (P<0.001) and that of AWE significantly increased the likelihood of aneurysm shrinkage (P=0.032).
AWE following EVAR may be associated with aneurysm shrinkage.
血管内动脉瘤修复（EVAR）后动脉瘤扩张及随之而来的内漏是一个主要问题。准确预测动脉瘤扩张对外科医生来说是一个挑战，目前仍然很困难。
我们回顾性分析了 157 例使用分叉主体支架移植物的腹主动脉瘤（AAA）的 EVAR 病例。EVAR 后有 62 例动脉瘤缩小，63 例动脉瘤稳定，32 例动脉瘤扩张。与稳定组（STB）和缩小组（SHR）相比，扩张组（EXP）的 I 型内漏明显增加（EXP：15.6% vs. STB：4.8% vs. SHR：0%，P=0.005）。EXP 组的 II 型内漏也明显增加（EXP：65.6% vs. STB：36.5% vs. SHR：6.5%，P<0.001）。然而，在影像学上，扩张组的瘤壁强化（AWE）明显降低（EXP：18.8% vs. STB：23.8% vs. SHR：53.2%，P<0.001）。多变量分析显示，II 型内漏的发生显著减少（P<0.001），AWE 的发生显著增加了动脉瘤缩小的可能性（P=0.032）。
EVAR 后 AWE 可能与动脉瘤缩小有关。
