Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy.
Department of Radiological Sciences, "Sapienza" University of Rome , Rome, Italy.
Expert Rev Cardiovasc Ther. 2020 Aug;18(8):465-473. doi: 10.1080/14779072.2020.1792294. Epub 2020 Jul 20.
In recent years there has been an increasing application of advanced EVAR techniques to tackle complex clinical and anatomical scenarios. In a bid to overcome the limitations of the traditional stent-grafts, newer EVAR endografts and techniques have been developed and introduced into clinical practice, permitting endovascular management of difficult infrarenal, juxta-renal and thoracoabdominal aneurysms for which previously there was no endovascular solution. As a consequence, we are now confronted with unique patterns of endoleak requiring customized clinical-radiological assessment and treatment. Despite the increasing body of evidence regarding new EVAR techniques and related endoleaks, current guidelines do not specifically address these issues.
Our review aims to assess risk factors, development, and management strategies of these endoleaks, in the most recent infrarenal EVAR devices and in more complex fenestrated EVAR (FEVAR) and Chimney EVAR (Ch-EVAR).
Most new devices have demonstrated types of endoleaks that need specific imaging and treatment, as in EVAS, FEVAR, and ChEVAR. Knowledge of specific stent-graft characteristics and the nature of endoleaks associated with the various procedures facilitates the application of relevant useful imaging. In addition, it should aid development of a customized and practically relevant approach to patient management during intervention and follow-up.
近年来，先进的 EVAR 技术在处理复杂的临床和解剖学场景中的应用越来越广泛。为了克服传统支架移植物的局限性，开发并引入了更新的 EVAR 内脏移植物和技术，从而能够对以前没有血管内解决方案的困难肾下、肾旁和胸腹主动脉瘤进行血管内管理。因此，我们现在面临着需要定制临床放射学评估和治疗的独特类型的内漏。尽管关于新的 EVAR 技术和相关内漏的证据越来越多，但目前的指南并没有专门解决这些问题。
我们的综述旨在评估最近的肾下 EVAR 装置和更复杂的开窗 EVAR（FEVAR）和烟囱 EVAR（Ch-EVAR）中这些内漏的危险因素、发展和管理策略。
大多数新型装置已经证明了需要特定成像和治疗的内漏类型，如在 EVAS、FEVAR 和 ChEVAR 中。了解特定支架移植物的特征以及与各种手术相关的内漏的性质有助于应用相关的有用成像。此外，它应该有助于制定针对介入和随访期间患者管理的定制和实用相关方法。
