Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Vascular Surgery, The First Affiliated Hospital of Huzhou University, Huzhou, China.
J Vasc Surg. 2022 Jun;75(6):1918-1925. doi: 10.1016/j.jvs.2021.12.053. Epub 2021 Dec 30.
In the present study, we evaluated and compared the outcomes of transarterial embolization with those of percutaneous contrast-enhanced ultrasound-guided transabdominal sac embolization (PUSE) for type II endoleaks (T2ELs).
A retrospective review was conducted of consecutive patients who had undergone T2EL embolization between January 2015 and December 2020 at our center. The cohort was divided into two groups according to the embolization approach: PUSE vs transarterial. Freedom from aneurysm growth, safety, immediate technical success, freedom from persistent T2ELs, and the repeat embolization rate were assessed.
A total of 25 patients and 28 embolization procedures (PUSE, n = 16; transarterial embolization, n = 12) were examined. Both the fluoroscopic time (13.3 ± 3.2 minutes vs 35.0 ± 7.0 minutes; P < .001) and the procedural time (84.9 ± 8.4 minutes vs 117.1 ± 14.8 minutes; P < .001) were significantly shorter in the PUSE group than in the transarterial group. After the embolization procedure, the patients were followed up for a mean duration of 24.7 ± 14.9 months for the PUSE group and 35.9 ± 21.1 months for the transarterial group (P = .1323). Five patients in the transarterial group had undergone unsuccessful embolization, with success in 7 of the 12 patients in the transarterial group and all 16 patients in the PUSE group (P = .0081). Failure had resulted from failed transarterial access or a recurrent T2EL. Three of the five patients had undergone subsequent PUSE during follow-up. No patient in the PUSE group had experienced sac expansion compared with four patients in the transarterial group (P = .0242). Similarly, no patient in the PUSE group had developed a newly discovered T2EL vs four patients in the transarterial group (P = .0242). Thus, the outcomes were markedly better for the PUSE group than were those for the transarterial group. A major procedure-related complication (abdominal abscess) occurred in one patient in the transarterial group.
PUSE is safe and effective for managing T2ELs. It yields better outcomes in terms of preventing aneurysm growth, decreasing the incidence of repeat embolization and complications, minimizing the recurrence of T2ELs, and reducing the fluoroscopic and procedural times. We, thus, regard it as the preferred approach for the management of T2ELs.
本研究旨在评估和比较经动脉栓塞术与经皮对比增强超声引导经腹囊栓塞术（PUSE）治疗 II 型内漏（T2EL）的疗效。
回顾性分析了 2015 年 1 月至 2020 年 12 月期间在我中心接受 T2EL 栓塞治疗的连续患者。根据栓塞方法将队列分为两组：PUSE 组与经动脉组。评估无瘤体生长、安全性、即刻技术成功、无持续 T2EL 及重复栓塞率。
共检查了 25 例患者和 28 例栓塞术（PUSE，n=16；经动脉栓塞术，n=12）。与经动脉组相比，PUSE 组的透视时间（13.3±3.2 分钟 vs 35.0±7.0 分钟；P<0.001）和操作时间（84.9±8.4 分钟 vs 117.1±14.8 分钟；P<0.001）明显缩短。栓塞术后，PUSE 组平均随访 24.7±14.9 个月，经动脉组平均随访 35.9±21.1 个月（P=0.1323）。经动脉组 5 例患者栓塞治疗失败，其中 7 例成功，12 例患者中 7 例成功，16 例 PUSE 组患者均成功（P=0.0081）。失败原因是经动脉入路失败或再次发生 T2EL。5 例患者中有 3 例在随访期间接受了后续 PUSE。与经动脉组的 4 例患者相比，无 PUSE 组患者出现囊腔扩张（P=0.0242）。同样，与经动脉组的 4 例患者相比，无 PUSE 组患者出现新发 T2EL（P=0.0242）。因此，与经动脉组相比，PUSE 组的结果明显更好。经动脉组有 1 例患者发生严重的与手术相关的并发症（腹部脓肿）。
PUSE 治疗 T2EL 安全有效。它在预防瘤体生长、降低重复栓塞和并发症发生率、最小化 T2EL 复发、减少透视和操作时间方面具有更好的效果。因此，我们认为它是治疗 T2EL 的首选方法。
