De León Ayala Iván Alejandro, Cheng Yu-Ting, Chen Shao-Wei, Chu Sung-Yu, Nan Yu-Yun, Liu Kuo-Sheng
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
J Thorac Cardiovasc Surg. 2022 Jun;163(6):2012-2021.e6. doi: 10.1016/j.jtcvs.2020.06.026. Epub 2020 Jun 27.
Thoracic endovascular aortic repair (TEVAR) can be complicated by a type Ia endoleak. However, its natural history remains unclear. This report describes the natural history and midterm outcome of conservatively treated type Ia endoleaks in the proximal aorta.
Between 2007 and 2015, 395 patients underwent TEVAR at our institution. Only TEVARs landing proximally at landing zones 0, 1, and 2 were included (221/395). Type Ia endoleak's flow was classified as "fast" or "slow" based on the time needed to visualize the aneurysmal sac during arteriogram.
The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for TEVAR; the incidence of type Ia endoleak was not statistically different. Forty-seven patients (21.3%) had a type Ia endoleak. TEVAR landing proximally at zone 1 increased the odds of developing a type Ia endoleak (odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P = .0072). The 30-day mortality and the overall survival was not influenced by the development of immediate-type Ia endoleak. In 34 (72.3%) patients, the endoleak resolved spontaneously. Ninety-four percent of these patients had a SlowE (n = 32/34). All of spontaneous resolutions occurred before the end of the first postoperative year.
SlowE tends to resolve within 1 year after TEVAR. Initial conservative treatment seems to be a reasonable approach in patients with SlowE.
胸主动脉腔内修复术（TEVAR）可能并发Ia型内漏。然而，其自然病程仍不清楚。本报告描述了近端主动脉Ia型内漏保守治疗的自然病程和中期结果。
2007年至2015年期间，395例患者在我院接受了TEVAR治疗。仅纳入近端锚定在0区、1区和2区的TEVAR（221/395）。根据动脉造影时观察到动脉瘤囊所需的时间，将Ia型内漏的血流分为“快”或“慢”。
中位随访时间为4.1年。主动脉夹层、胸主动脉瘤和创伤性主动脉损伤是TEVAR最常见的适应证；Ia型内漏的发生率无统计学差异。47例患者（21.3%）发生Ia型内漏。近端锚定在1区的TEVAR增加了发生Ia型内漏的几率（优势比，2.8；95%置信区间，1.3 - 5.9；P = 0.0072）。即刻型Ia型内漏的发生不影响30天死亡率和总生存率。34例（72.3%）患者的内漏自发消失。这些患者中94%为慢血流内漏（n = 32/34）。所有自发消失均发生在术后第一年末之前。
慢血流内漏倾向于在TEVAR术后1年内消失。对于慢血流内漏患者，初始保守治疗似乎是一种合理的方法。
