Arenas Azofra Ernesto, Rey Vicente Mosquera, Marcos Francisco Álvarez, Al-Sibbai Amer Zanabili, García Florentino Vega, Pérez Manuel Alonso
Vascular Surgery Department, Asturias University Central Hospital (HUCA), Oviedo, Spain.
Vascular Surgery Department, Asturias University Central Hospital (HUCA), Oviedo, Spain.
Ann Vasc Surg. 2020 Jul;66:104-109. doi: 10.1016/j.avsg.2019.05.020. Epub 2019 Aug 2.
Type 2 endoleaks (T2Es) are the main cause of reintervention after endovascular repair of abdominal aortic aneurysms (EVAR). The objective of this study is to quantify success rates of T2E treatment.
This study involves a retrospective analysis of a prospectively maintained database containing data on all consecutive patients treated for a T2E between 2003 and 2017 in a single center. Technical success was defined as absence of endoleak in the final angiographic control after treatment. Clinical success was defined as absence of sac growth over 5 mm in the contrast-enhanced computed tomography performed a year thereafter. Statistics included Kaplan-Meier survival estimates.
A total of 528 elective EVARs were performed in the period. Thirty-six of these (6.8%) developed a T2E requiring reintervention, a median of 37.9 months after EVAR. Twenty-five percent of the treatments were performed more than 5 years after intervention. Twenty-eight of the 36 treatments were performed via transarterial embolization. For this technique, technical success was 71.4% and clinical success was 62.5%. A subsequent reintervention was required in 35.7% of patients. In this cohort, the rate of aneurysm rupture was 10.7% (n = 3/28), open surgical conversion was needed in 2 of 28 cases (7.1%), and rate of aneurysm-related death was 14.3% (n = 4/28) over follow-up.
A high percentage of patients are at risk of adverse outcomes after T2E treatment. Strict imaging follow-up is still needed in this population.
2型内漏（T2E）是腹主动脉瘤血管内修复术（EVAR）后再次干预的主要原因。本研究的目的是量化T2E治疗的成功率。
本研究对一个前瞻性维护的数据库进行回顾性分析，该数据库包含2003年至2017年在单一中心接受T2E治疗的所有连续患者的数据。技术成功定义为治疗后最终血管造影检查无内漏。临床成功定义为在其后一年进行的对比增强计算机断层扫描中，瘤体生长不超过5毫米。统计分析包括Kaplan-Meier生存估计。
在此期间共进行了528例择期EVAR。其中36例（6.8%）发生T2E需要再次干预，EVAR术后中位时间为37.9个月。25%的治疗在干预后5年以上进行。36例治疗中有28例通过经动脉栓塞进行。对于该技术，技术成功率为71.4%，临床成功率为62.5%。35.7%的患者需要后续再次干预。在该队列中，随访期间动脉瘤破裂率为10.7%（n = 3/28），28例中有2例（7.1%）需要转为开放手术，动脉瘤相关死亡率为14.3%（n = 4/28）。
T2E治疗后，很大比例的患者有不良结局风险。该人群仍需要严格的影像学随访。
