Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Department of Surgery, Amsterdam, the Netherlands.
Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Department of Surgery, Amsterdam, the Netherlands.
Eur J Vasc Endovasc Surg. 2021 May;61(5):779-786. doi: 10.1016/j.ejvs.2021.01.017. Epub 2021 Feb 23.
The aims of the present study were to examine the impact of type 2 endoleaks (T2EL) on overall survival and to determine the need for secondary intervention after endovascular aneurysm repair (EVAR).
A multicentre retrospective cohort study in the Netherlands was conducted among patients with an infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between 2007 and 2012. The primary endpoint was overall survival for patients with (T2EL+) or without (T2EL-) a T2EL. Secondary endpoints were sac growth, AAA rupture, and secondary intervention. Kaplan-Meier survival and multivariable Cox regression analysis were used.
A total of 2 018 patients were included. The median follow up was 62.1 (range 0.1 - 146.2) months. No difference in overall survival was found between T2EL+ (n = 388) and T2EL- patients (n = 1630) (p = .54). The overall survival estimates at five and 10 years were 73.3%/69.4% and 45.9%/44.1% for T2EL+/T2EL- patients, respectively. Eighty-five of 388 (21.9%) T2EL+ patients underwent a secondary intervention. There was no difference in overall survival between T2EL+ patients who underwent a secondary intervention and those who were treated conservatively (p = .081). Sac growth was observed in 89 T2EL+ patients and 44/89 patients (49.4%) underwent a secondary intervention. In 41/44 cases (93.1%), sac growth was still observed after the intervention, but was left untreated. Aneurysm rupture occurred in 4/388 T2EL patients. In Cox regression analysis, higher age, ASA classification, and maximum iliac diameter were significantly associated with worse overall survival.
No difference in overall survival was found between T2EL+ and T2EL- patients. Also, patients who underwent a secondary intervention did not have better survival compared with those who did not undergo a secondary intervention. This study reinforces the need for conservative treatment of an isolated T2EL and the importance of a prospective study to determine possible advantages of the intervention.
本研究旨在探讨 2 型内漏（T2EL）对总生存率的影响，并确定血管内动脉瘤修复（EVAR）后是否需要二次干预。
在荷兰进行了一项多中心回顾性队列研究，纳入了 2007 年至 2012 年间接受 EVAR 的腹主动脉瘤（AAA）患者。主要终点是 T2EL（T2EL+）患者和无 T2EL（T2EL-）患者的总生存率。次要终点是瘤囊生长、AAA 破裂和二次干预。使用 Kaplan-Meier 生存分析和多变量 Cox 回归分析。
共纳入 2018 例患者。中位随访时间为 62.1（0.1-146.2）个月。T2EL+（n=388）和 T2EL-患者（n=1630）之间的总生存率无差异（p=0.54）。T2EL+/T2EL-患者的 5 年和 10 年总生存率估计值分别为 73.3%/69.4%和 45.9%/44.1%。388 例 T2EL+患者中有 85 例接受了二次干预。接受二次干预和保守治疗的 T2EL+患者之间的总生存率无差异（p=0.081）。89 例 T2EL+患者出现瘤囊生长，其中 44 例（49.4%）接受了二次干预。在 41 例（93.1%）情况下，干预后仍观察到瘤囊生长，但未进行治疗。4 例 T2EL 患者发生 AAA 破裂。在 Cox 回归分析中，年龄较大、ASA 分级和最大髂径与总生存率显著相关。
T2EL+和 T2EL-患者之间的总生存率无差异。此外，接受二次干预的患者与未接受二次干预的患者相比，生存率并未改善。本研究再次强调了对孤立性 T2EL 进行保守治疗的必要性，以及进行前瞻性研究以确定干预可能带来的优势的重要性。
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