Torres-Blanco Álvaro, Miralles-Hernández Manuel
Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario y Politécnico La Fe, Av/ Fernando Abril Martorell 106, 46026, Valencia, Spain.
Department of Surgery, University of Valencia, Valencia, Spain.
CVIR Endovasc. 2021 Jun 5;4(1):46. doi: 10.1186/s42155-021-00238-2.
Use of the term endotension in the treatment of aortic aneurysm is currently controversial. Initially it was proposed to define the circumstance in which there is an enlargement of the aneurysm sac after endovascular repair without a demonstrable endoleak. The term was established with the aim of transmitting the possibility of causes other than pressure applying stress to the aneurysm wall. Twenty years have passed since the proposal of this terminology was published. The literature is reviewed with the purpose of providing an update on advances in the knowledge of the possible etiological mechanisms. The experimental studies call into question that causes other than pressure determine the increase of the aneurysm. On the basis of this review, the term `Sac Expansion Without Evident Leak´ (SEWEL) is proposed as a more accurate and precise denomination for what is aimed to be defined. Evidence suggests that the more likely mechanisms of persistent pressurization of the aneurysm sac are an unidentified endoleak (likely type I or low-flow Type II) or thrombus occluding wide and short channels that connects with the excluded aneurysm sac (at the attachment sites of the stent-graft or at the branch vessels orifices).
在主动脉瘤治疗中使用“内张力”一词目前存在争议。最初提出该词是为了定义血管腔内修复后动脉瘤囊扩大但无明显内漏的情况。该术语的提出旨在传达除压力之外其他因素对动脉瘤壁施加应力的可能性。自该术语提出至今已有二十年。本文对相关文献进行综述，目的是更新关于可能病因机制的知识进展。实验研究对除压力之外的其他因素决定动脉瘤增大这一观点提出了质疑。基于此综述，建议使用“无明显渗漏的囊袋扩张”（SEWEL）这一术语来更准确、精确地定义目标情况。有证据表明，动脉瘤囊持续受压的更可能机制是未识别的内漏（可能是I型或低流量II型）或血栓阻塞与被隔绝的动脉瘤囊相连的宽而短的通道（在支架移植物的附着部位或分支血管开口处）。
