Department of Vascular Surgery, Stony Brook University, Stony Brook, New York, USA.
Department of Surgery, Lenox Hill Hospital, New York City, New York, USA.
Ann Vasc Surg. 2021 Aug;75:406-419. doi: 10.1016/j.avsg.2021.01.083. Epub 2021 Feb 4.
The aim in this study was to systematically review the literature to identify the time of occurrence of a newly diagnosed Type II endoleak (T2E) following an endovascular aneurysm repair (EVAR) for an infrarenal abdominal aortic aneurysm (AAA) and its potential impact on aneurysmal sac diameter changes.
A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane until January 2020. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity.
Thirty-three observational studies were deemed eligible and provided data for 2643 T2E detected following EVAR. A total of 1432 (54.2%) T2E were diagnosed before 30 days follow-up, while 1035 (39.1%) T2E were diagnosed beyond 30 days following EVAR. A total of 222 (8.4%) T2E were diagnosed after 12 months of follow-up. A pooled meta-analysis of 6 studies, showed that early diagnosed T2E had a statistically significant higher odds of resolving as compared to those detected late (OR: 2.41; 95% CI: 1.14-5.09; P = 0.021; I = 68.9%). Sac expansion was documented in 313 (29%) T2E. The ruptured endoleaks were 14 (1.1%).
The occurrence of a T2E is a dynamic process detected throughout the lifetime of a patient with 8% detected beyond 12 months following EVAR. Long-term follow up is required with future prospective studies with consist reporting on changes in sac diameter, the thrombus characteristics. Long-term outcomes are needed to optimize management of patients with a newly diagnosed T2E.
本研究旨在通过系统回顾文献，确定腹主动脉瘤腔内修复术（EVAR）后新发 II 型内漏（T2E）的发生时间及其对瘤囊直径变化的潜在影响。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行全面的系统回顾。通过搜索 PubMed、Scopus 和 Cochrane 数据库，直到 2020 年 1 月，确定了符合条件的研究。使用随机效应模型进行荟萃分析。I 平方统计量用于评估异质性。
33 项观察性研究被认为符合条件，并提供了 2643 例 EVAR 后检测到的 T2E 数据。共有 1432 例（54.2%）T2E 在 30 天随访前诊断，而 1035 例（39.1%）T2E 在 EVAR 后 30 天以上诊断。共有 222 例（8.4%）T2E 在随访 12 个月后诊断。对 6 项研究的汇总荟萃分析显示，与晚期诊断的 T2E 相比，早期诊断的 T2E 有更高的统计学可能性得到解决（OR：2.41；95%CI：1.14-5.09；P=0.021；I=68.9%）。313 例（29%）T2E 记录了瘤囊扩张。破裂的内漏有 14 例（1.1%）。
T2E 的发生是一个动态过程，在患者的一生中都能被检测到，8%的 T2E 在 EVAR 后 12 个月后被检测到。需要进行长期随访，并进行未来的前瞻性研究，对瘤囊直径变化、血栓特征进行一致的报告。需要长期的结果来优化新发 T2E 患者的管理。
