Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Department of Surgery, Zaans Medisch Centrum, Zaandam The Netherlands.
Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands.
J Vasc Surg. 2021 Sep;74(3):1024-1032. doi: 10.1016/j.jvs.2021.03.061. Epub 2021 May 1.
The long-term success of endovascular aneurysm repair (EVAR) is limited by complications, most importantly endoleaks. In case of (persistent) type I endoleak (T1EL), secondary intervention is indicated to prevent secondary aneurysm rupture. Different treatment options are suggested for T1ELs, such as endo anchors, (fenestrated) cuffs, embolization, or open conversion. Currently, the treatment of T1EL with liquid embolic agents is available; however, results are not yet addressed. This review presents the safety and efficacy of embolization with liquid embolic agents for treatment of T1ELs after EVAR.
A systematic literature search was performed for all studies reporting the use of liquid embolic agents as monotherapy for treatment of T1ELs after EVAR. Patient numbers, technical success (successful delivery of liquid embolics in the T1EL) and clinical success (absence of aneurysm related death, endoleak recurrence or additional interventions during follow-up) were examined.
Of 1604 articles, 10 studies met the selection criteria, including 194 patients treated with liquid embolics; 73.2% of the patients were male with a median age of 71 years. The overall technical success was 97.9%. Clinical success was 87.6%. Because the median follow-up was only 13.0 months (range, 1-89 months), data on long-term success are almost absent. Four cases (2.1%) of secondary aneurysm rupture after embolization owing to endoleak recurrence were reported. All ruptures occurred in aneurysms exceeding initial treatment diameter of 70 mm.
Initial technical success after liquid embolization for T1EL is high, although long-term clinical success rates are lacking. Within this review, the risk of secondary rupture is comparable with untreated T1EL at 2% with a median follow-up of 13 months, regardless of the initial success of embolization. In general, no decrease in secondary aneurysm rupture after embolization of T1EL after EVAR is demonstrated, although the results of late embolization are debated.
血管内动脉瘤修复术（EVAR）的长期成功受到并发症的限制，其中最重要的是内漏。在（持续性）Ⅰ型内漏（T1EL）的情况下，需要进行二次干预以防止二次动脉瘤破裂。对于 T1EL，有不同的治疗选择，如内锚定物、（开窗）袖带、栓塞或开放转换。目前，可使用液体栓塞剂治疗 T1EL；然而，结果尚未得到解决。本综述介绍了 EVAR 后使用液体栓塞剂治疗 T1EL 的安全性和有效性。
对所有报告使用液体栓塞剂作为单一疗法治疗 EVAR 后 T1EL 的研究进行了系统文献检索。检查了患者数量、技术成功率（液体栓塞剂成功输送至 T1EL）和临床成功率（无动脉瘤相关死亡、内漏复发或随访期间需要额外干预）。
在 1604 篇文章中，有 10 项研究符合入选标准，共纳入 194 例接受液体栓塞剂治疗的患者；73.2%的患者为男性，中位年龄为 71 岁。总体技术成功率为 97.9%。临床成功率为 87.6%。由于中位随访时间仅为 13.0 个月（范围 1-89 个月），几乎没有长期成功的数据。有 4 例（2.1%）患者因内漏复发导致二次动脉瘤破裂，均发生在初始治疗直径超过 70mm 的动脉瘤中。
液体栓塞治疗 T1EL 的初始技术成功率较高，尽管缺乏长期临床成功率数据。在本综述中，无论栓塞的初始成功率如何，在 13 个月的中位随访时间内，二次破裂的风险与未经治疗的 T1EL 相似，为 2%。一般来说，在 EVAR 后 T1EL 的栓塞治疗中，没有显示出二次动脉瘤破裂的减少，尽管晚期栓塞的结果存在争议。
