Moulakakis Konstantinos G, Lazaris Andreas M, Kakisis John D, Sfyroeras George S, Theocharopoulos George, Panagiotopoulos Andreas I, Krinos Nikolas, Geroulakos George
Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
Aorta (Stamford). 2020 Aug;8(4):98-103. doi: 10.1055/s-0040-1714123. Epub 2020 Dec 11.
Aortic neck wall rupture during endovascular repair of abdominal aortic aneurysms (EVAR) is an underreported potentially fatal complication. Only a few cases have been reported. The main cause of this complication is repeated attempts at balloon inflation or overdilation to treat an intraoperative Type 1a endoleak. We report three cases complicated by procedure-related aortic neck wall rupture during EVAR. We also review the literature regarding the causes and outcomes of this complication.
Medical records of all patients undergoing EVAR between January 2009 and March 2019 were retrospectively reviewed.
Overall, 824 EVAR procedures were performed, and rupture of the aortic neck wall was observed in three patients. In all cases, a Type 1a endoleak was observed and, in all cases, repeated ballooning attempts had been performed to resolve the endoleaks. In all cases, conversion to open repair was performed and all patients survived.
In cases of Type 1a endoleak, a maximum of two ballooning attempts should be performed even if a Type 1a endoleak persists. In case of intraoperative aortic neck wall rupture, control of the hemorrhage should be achieved immediately by advancing the balloon above the site of rupture. Emergency surgical conversion in case of hemodynamic stability is the first choice. According to the literature, emergency surgical conversion, especially in cases of endograft with suprarenal fixation, is associated with significant morbidity and mortality rates, mainly due to hemorrhage and to the length of the procedure required to repair the aortic neck wall injury.
腹主动脉瘤腔内修复术（EVAR）期间主动脉颈部壁破裂是一种报道不足的潜在致命并发症。仅有少数病例被报道。该并发症的主要原因是为治疗术中1a型内漏而反复进行球囊扩张或过度扩张。我们报告3例EVAR期间并发与手术相关的主动脉颈部壁破裂的病例。我们还回顾了关于该并发症的病因和结局的文献。
回顾性分析2009年1月至2019年3月期间所有接受EVAR治疗的患者的病历。
总体而言，共进行了824例EVAR手术，3例患者观察到主动脉颈部壁破裂。所有病例均观察到1a型内漏，且所有病例均反复进行球囊扩张尝试以解决内漏。所有病例均转为开放修复，所有患者均存活。
对于1a型内漏病例，即使1a型内漏持续存在，最多应进行两次球囊扩张尝试。术中发生主动脉颈部壁破裂时，应立即将球囊推进至破裂部位上方以控制出血。血流动力学稳定时紧急手术转为开放修复是首选。根据文献，紧急手术转为开放修复，尤其是使用肾上固定的腔内移植物的病例，与显著的发病率和死亡率相关，主要原因是出血以及修复主动脉颈部壁损伤所需的手术时间。
