de la Motte Louise, Falkenberg Mårten, Koelemay Mark J, Lönn Lars
Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark -
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
J Cardiovasc Surg (Torino). 2018 Apr;59(2):201-212. doi: 10.23736/S0021-9509.18.10388-0. Epub 2018 Jan 9.
Indications for reinterventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, postprocedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on reinterventions after elective EVAR.
Qualitative review of studies reporting on reinterventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASE and the Cochrane Library for publications from 2010 to 13th of November 2017.
Twenty-three studies reporting on 83,307 patients met the inclusion criteria. Index procedures were performed between 1996-2014. There was wide heterogeneity in reporting standards. Type I endoleaks were reported in 0.6%-13% and type III endoleaks in 0.9-2.1% with a significant improvement for newer devices. Migration rates varied between 0-4%. Endoleak type II was the most common indication for re-intervention ranging from 14-25.3% although the majority resolved without intervention. Rupture rates ranged from 0-5.4% and carried a high mortality (60-67%). Ruptures occurred at any time after the index procedure. Limb ischemia rates were reported at 0.4-11.9% with re-intervention rates between 0.06-11.9%. Wound related complications and related re-interventions were the indication in 0.5-14% and 0.3-6.5%, respectively. Endograft infection carried a high risk of mortality and was described in 0.3-3.6%, often related to graft-enteric fistula and the majority had an open explantation of the endograft.
This review showed that the rates of complications and techniques for reintervention developed over time with a tendency towards better outcomes considering the aneurysm related indications. Significant factors that led to subsequent secondary interventions were migration, rupture, infections and type I and II endoleaks. Patients treated with earlier generation endografts are still alive and need continued surveillance to detect these severe complications before they lead to rupture.
血管内动脉瘤修复术（EVAR）后再次干预的指征，以及其发生的数量和时间，对于优化患者选择、术后监测以及指导血管内支架移植物设计的改进都很重要。本报告的目的是概述择期EVAR术后再次干预的当前数据。
通过在MEDLINE、EMBASE和Cochrane图书馆进行系统文献检索，对2010年至2017年11月13日期间报道择期EVAR术后再次干预的研究进行定性综述。
23项报道83307例患者的研究符合纳入标准。首次手术于1996年至2014年期间进行。报告标准存在很大异质性。I型内漏的报道发生率为0.6%-13%，III型内漏为0.9%-2.1%，新型器械有显著改善。移位率在0%-4%之间。II型内漏是再次干预最常见的指征，发生率为14%-25.3%，不过大多数无需干预即可自行缓解。破裂率为0%-5.4%，死亡率很高（60%-67%）。破裂可发生在首次手术后的任何时间。肢体缺血率报道为0.4%-11.9%，再次干预率为0.06%-11.9%。伤口相关并发症及相关再次干预的指征分别为0.5%-14%和0.3%-6.5%。血管内支架移植物感染死亡率很高，报道发生率为0.3%-3.6%，常与移植物-肠瘘有关，大多数患者需对血管内支架移植物进行开放性取出。
本综述表明，考虑到与动脉瘤相关的指征，并发症发生率和再次干预技术随时间推移有所发展，且有预后改善的趋势。导致后续二次干预的重要因素包括移位、破裂、感染以及I型和II型内漏。接受早期血管内支架移植物治疗的患者仍然存活，需要持续监测以在这些严重并发症导致破裂前将其检测出来。
