Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands.
J Endovasc Ther. 2022 Feb;29(1):57-65. doi: 10.1177/15266028211031933. Epub 2021 Aug 3.
Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR.
This is an international, retrospective, observational cohort study including data from 8 European institutions.
A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5-89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%.
The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.
血管内修复（EVAR）后出现的 III 型内漏会增加动脉瘤囊内的压力，从而增加破裂风险，因此需要进行治疗。使用常规的血管内设备进行治疗可能较为困难。血管内动脉瘤密封（EVAS）可能为 III 型内漏提供一种治疗选择，尤其是在靠近分流器的部位。本研究旨在分析 EVAR 后 EVAS 治疗 III 型内漏的临床效果。
这是一项国际性、回顾性、观察性队列研究，纳入了来自 8 个欧洲机构的数据。
共确定了 20 例患者，其中 80%的患者存在 IIIb 型内漏，其余 20%的患者存在 IIIa 型内漏。EVAR 与 EVAS 之间的中位时间为 49.5 个月（28.5-89）。EVAS 修正前 AAA 直径的平均值为 76.6±19.9mm。技术成功率为 95%，1 例患者因术后心肌梗死导致死亡而发生技术失败。平均随访时间为 22.8±15.2 个月。随访期间，1 例患者出现 I 型内漏，1 例患者在未经治疗的部位出现新的 IIIa 型内漏。有 5 例患者出现了动脉瘤生长。5 例患者因 AAA 相关再干预而进行治疗，其指征为：存在 II 型内漏（n=3）、I 型内漏（n=1）和髂动脉瘤（n=1）。在 1 年的随访中，无临床失败率为 77.5%，全因死亡率为 94.7%，动脉瘤相关死亡率为 95%，动脉瘤相关再干预率为 93.8%。
EVAS 再衬垫可以安全地用于治疗 III 型内漏，其技术成功率可接受，30 天死亡率较低，在短期随访中没有二次破裂。相对较低的临床成功率与再干预和 AAA 增大有关，这突显了需要进行长期随访。
