Blakeslee-Carter Juliet, Beck Adam, Spangler Emily
Vascular Surgery and Endovascular Therapy, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
BMJ Surg Interv Health Technol. 2020 Dec;2(1). doi: 10.1136/bmjsit-2020-000054.
Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressure. Previous studies have found a ~2% incidence of T3EL after standard infrarenal endovascular aneurysm repair (EVAR); however, no prior studies with new-generation devices have been able to determine an association between T3EL and clinical outcomes. Here we examine T3EL within the Society for Vascular Surgery Vascular Quality Initiative (VQI) to define rates of occurrence, rates and modes of reintervention, and clinical consequences of these endoleaks.
Participants receiving infrarenal EVAR in the VQI from January 2003 to September 2018 were analyzed in a retrospective cohort study.
Of 42 246 entries in the EVAR procedural registry, 41 604 had complete procedural information and were included in analysis. Of these, 36 082 had long-term follow-up, and 26 422 had follow-up (9-21 months per VQI reporting standards) with complete endoleak data recorded.
All patients included in this study underwent an infrarenal EVAR.
Within the VQI database, the rate of T3EL in infrarenal EVAR during index hospitalization was 0.37% (n=157/41 604), of which 85% were due to midgraft separation and 15% were due to fabric disruptions. Out of the 157 index hospitalization T3ELs, 4.5% (n=7) received procedural reintervention during that hospitalization, which accounted for 1% of all index hospitalization reinterventions. During the 21-month follow-up, the rate of incident T3EL was 0.7% (n=205/26 422), which accounted for 5% of all endoleaks seen during follow-up. Reinterventions for incident T3EL at follow-up were done in 30 patients (rate 0.1%), which accounted for 9% of endoleak reinterventions and 3.3% of all reinterventions. The presence of incident T3EL found during follow-up was associated with a significant decrease in 5-year survival (74% vs 80%, respectively; p=0.041) in Kaplan-Meier analysis.
T3ELs rates at placement and follow-up remain low; however, the majority reported in long-term follow-up are incident and these incident endoleaks are associated with decreased survival in EVAR.
3型内漏（T3ELs）表示动脉瘤未受到系统压力的保护。既往研究发现，标准肾下腔内动脉瘤修复术（EVAR）后T3EL的发生率约为2%；然而，此前尚无关于新一代器械的研究能够确定T3EL与临床结局之间的关联。在此，我们在血管外科学会血管质量倡议（VQI）中研究T3EL，以明确其发生率、再次干预的发生率和方式，以及这些内漏的临床后果。
在一项回顾性队列研究中，分析了2003年1月至2018年9月在VQI中接受肾下EVAR的参与者。
在EVAR手术登记处的42246条记录中，41604条具有完整的手术信息并纳入分析。其中，36082条有长期随访记录，26422条有随访记录（按照VQI报告标准为9至21个月），且记录了完整的内漏数据。
本研究纳入的所有患者均接受了肾下EVAR。
在VQI数据库中，初次住院期间肾下EVAR的T3EL发生率为0.37%（n = 157/41604），其中85%是由于移植物中段分离，15%是由于人工血管破损。在157例初次住院时发生的T3EL中，4.5%（n = 7）在该次住院期间接受了手术再次干预，占所有初次住院再次干预的1%。在21个月的随访期间，新发T3EL的发生率为0.7%（n = 205/26422），占随访期间所见所有内漏的5%。随访期间对新发T3EL进行再次干预的有30例患者（发生率0.1%），占内漏再次干预的9%和所有再次干预的3.3%。在Kaplan-Meier分析中，随访期间发现的新发T3EL与5年生存率显著降低相关（分别为74%和80%；p = 0.041）。
放置时和随访时的T3EL发生率仍然较低；然而，长期随访中报告的大多数是新发的，且这些新发内漏与EVAR患者生存率降低相关。
