Mozes Gergely D, Pather Keouna, Oderich Gustavo S, Mirza Aleem, Colglazier Jill J, Shuja Fahad, Mendes Bernardo C, Kalra Manju, Bjarnason Haraldur, Bower Thomas C, Huang Ying, Gloviczki Peter, DeMartino Randall R
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Ann Vasc Surg. 2020 Aug;67:223-231. doi: 10.1016/j.avsg.2020.02.013. Epub 2020 Mar 13.
Type II endoleaks (T2ELs) are common following endovascular repair of abdominal aortic aneurysms (EVAR). Embolization with ethylene vinyl alcohol copolymer (Onyx) may present an effective treatment alternative for T2ELs. Due to limited data supporting its use, we sought to analyze outcomes of Onyx embolization for T2ELs.
Retrospective review of consecutive patients treated for T2ELs utilizing Onyx embolization agent from 2009-2018. All pre- and post-Onyx intervention CT scans were analyzed for diameter and volume changes with 3D reconstruction software. The primary outcomes were change in maximum AAA diameter and volume. Secondary outcomes included additional interventions, rupture, and mortality. A subset analysis was performed with patients with isolated T2ELs (no other types of endoleaks present).
We identified 85 patients (73 males, mean age 77.6 ± 7.6 years) who underwent 112 Onyx interventions. Average time to first Onyx intervention after index EVAR was 3.3 ± 2.6 years and average sac growth was 6.3 ± 6.7 mm. Patients underwent mean 1.3 Onyx interventions using a mean of 4.9 ± 4.7 ml for treatment. Three complications occurred (Onyx extravasation, colon ischemia, and access site hematoma). Mean follow-up was 2.5 ± 2.1 years after initial Onyx treatment. At the most recent follow-up, sac diameter stabilization was seen in 47% and reduction >5 mm was seen in 19%. Sac growth of >5 mm was seen in 34% of patients following the first Onyx intervention. In our subset of isolated T2EL, 72% had sac stabilization or reduction >5 mm. Four patients experienced a ruptured aneurysm (3 had active type 1 endoleaks). Rupture-free survival was 95% at 5 years, and overall survival was 54% at 5 years. Notably, increasing Onyx interventions were not associated with sac stabilization or reduction (OR 0.6, P = 0.1). On multivariable analysis, AAA sac diameter stabilization or reduction was independently associated with BMI >30 kg/m (OR 4.2, P = 0.01) and having only 1 Onyx intervention (OR 3.8, P = 0.02).
Onyx for embolization of T2ELs resulted in AAA sac diameter stabilization or reduction in 66% of patients, and up to 72% in isolated T2ELs. Further, increasing Onyx interventions were not associated with either aneurysm sac stabilization or reduction. Given its similar outcomes to other embolization strategies in the literature, Onyx embolization for management of T2ELs needs to be judiciously considered, particularly for T2ELs persisting after an initial Onyx embolization intervention.
Ⅱ型内漏（T2ELs）是腹主动脉瘤血管内修复术（EVAR）后常见的并发症。用乙烯-乙烯醇共聚物（Onyx）进行栓塞可能是治疗T2ELs的一种有效替代方法。由于支持其使用的数据有限，我们试图分析Onyx栓塞治疗T2ELs的效果。
回顾性分析2009年至2018年期间使用Onyx栓塞剂治疗T2ELs的连续患者。使用三维重建软件分析所有Onyx干预前后的CT扫描，以观察直径和体积变化。主要结局是腹主动脉瘤最大直径和体积的变化。次要结局包括额外干预、破裂和死亡率。对孤立性T2ELs（无其他类型内漏）患者进行亚组分析。
我们确定了85例患者（73例男性，平均年龄77.6±7.6岁），他们接受了112次Onyx干预。初次EVAR后至首次Onyx干预的平均时间为3.3±2.6年，瘤腔平均增大6.3±6.7mm。患者平均接受1.3次Onyx干预，平均使用4.9±4.7ml进行治疗。发生了3例并发症（Onyx渗漏、结肠缺血和穿刺部位血肿）。初次Onyx治疗后的平均随访时间为2.5±2.1年。在最近的随访中，47%的患者瘤腔直径稳定，19%的患者瘤腔直径缩小>5mm。首次Onyx干预后，34%的患者瘤腔增大>5mm。在我们的孤立性T2ELs亚组中，72%的患者瘤腔稳定或缩小>5mm。4例患者发生动脉瘤破裂（3例有活动性Ⅰ型内漏）。5年时无破裂生存率为95%，5年总生存率为54%。值得注意的是，增加Onyx干预与瘤腔稳定或缩小无关（OR=0.6，P=0.1）。多变量分析显示，腹主动脉瘤瘤腔直径稳定或缩小与BMI>30kg/m²（OR=4.2，P=0.01）和仅接受1次Onyx干预（OR=3.8，P=0.02）独立相关。
Onyx栓塞T2ELs使66%的患者腹主动脉瘤瘤腔直径稳定或缩小，孤立性T2ELs患者中这一比例高达72%。此外
