Cardiovascular Care Group, Westfield, NJ.
Cardiovascular Care Group, Westfield, NJ; Division of Vascular Surgery, Overlook Medical Center, Summit, NJ.
J Vasc Surg. 2019 Apr;69(4):1309-1313. doi: 10.1016/j.jvs.2018.08.177.
The management of type II endoleaks that develop after endovascular repair of aortic aneurysms now includes the transcaval approach. We reviewed the safety and efficacy of this technique in 10 consecutive patients (82 ± 7 years old; 80% male) who presented with a mean sac enlargement of 1.2 ± 0.7 cm and documented flow within the aortic sac. Patients presented a mean of 5.5 ± 3.1 years after endovascular aneurysm repair, and five (50%) patients had prior attempts at endovascular repair of the documented endoleak. Patients underwent a percutaneous transcaval approach to the aorta with use of the Rösch-Uchida Transjugular Liver Access Kit (Cook Medical, Bloomington, Ind) through an 8F sheath in a biplane angiography room. Coil embolization of the sac and lumbar arteries and occasional use of gelatin granules and human thrombin slurry allowed obliteration of the endoleak. No complications developed. Nine patients (90%) were noted to have a decreased sac diameter on the postprocedure study, and only one (10%) had persistent (but markedly diminished) flow noted on the follow-up ultrasound examination. Follow-up is early and extends to 6 months without recurrence of the endoleaks. The ability to safely access the aortic sac through the vena cava is a potentially efficient, safe, and useful technique to treat aortic endoleaks.
现在，对于主动脉瘤血管内修复后出现的 II 型内漏，其管理方法包括经腔静脉入路。我们回顾了 10 例连续患者（82±7 岁；80%为男性）采用该技术的安全性和有效性，这些患者的平均囊腔增大为 1.2±0.7cm，且在主动脉囊腔内有记录到血流。患者在血管内动脉瘤修复后平均 5.5±3.1 年出现，其中 5 例（50%）患者先前曾尝试过经血管内修复记录到的内漏。患者在双平面血管造影室中，通过 8F 鞘管使用 Rösch-Uchida 经颈静脉肝内入路套件（美国库克医疗公司，印第安纳州布卢明顿）进行经腔静脉入路至主动脉。通过弹簧圈栓塞囊腔和腰动脉，偶尔使用明胶颗粒和人凝血酶浆，可使内漏闭塞。未发生任何并发症。9 例患者（90%）在术后研究中发现囊腔直径减小，仅 1 例（10%）在后续超声检查中发现持续（但明显减少）的血流。随访时间尚早，最长为 6 个月，未再出现内漏。通过腔静脉安全地进入主动脉囊腔是一种有潜在效率、安全且有用的治疗主动脉内漏的技术。
