经导管腔静脉栓塞治疗腹主动脉瘤腔内修复术后 II 型内漏的系统评价。
Systematic review on transcaval embolization for type II endoleak after endovascular aortic aneurysm repair.
机构信息
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany.
出版信息
J Vasc Surg. 2022 Jul;76(1):282-291.e2. doi: 10.1016/j.jvs.2022.02.032. Epub 2022 Mar 4.
BACKGROUND
A persistent endoleak type II (ET II) after endovascular repair for aortic aneurysms is not always a benign condition and has been associated to sac expansion, rupture, and reintervention. A variety of different endovascular approaches are available for ET II treatment. The aim of this systematic review was to assess the currently available literature on transcaval embolization for ET II treatment after standard or complex endovascular aortic aneurysm repair.
METHODS
This systematic review protocol was registered to the PROSPERO (CRD42021289686). The PRISMA guidelines and patient, intervention, comparison, outcome (P.I.C.O.) model was followed. A data search of the literature was conducted, using PubMed, EMBASE via Ovid, and CENTRAL databases, until September 30, 2021. Only studies reporting on ET II embolization using the transcaval approach after endovascular aneurysm repair were included. Studies reporting on different type of endoleak treatment or any other embolization approach were excluded. The quality of studies was assessed using the Newcastle-Ottawa Scale. Primary outcomes were technical success and freedom from ET II persistence during follow-up; secondary outcomes were any postoperative complication associated with the transcaval embolization and need for reintervention.
RESULTS
The search yielded 2861 articles in total. Eight articles were included, reporting on 117 patients and 128 transcaval embolizations. The indication for treatment was ET II presence with sac expansion of more than 5 mm; in two studies, the presence of persistent endoleak has set the indication to intervene. The technical success was 91.4% (117/128); a variety of embolic materials were used, including coils, thrombin, and glue. Three cases of deep vein thrombosis were recorded and the remaining morbidity and mortality were null. Follow-up was ranging between 0 and 25 months. Out of 8 studies, persistent ET II rate was 12.8% and 18 reinterventions were performed (14.1%,), including 10 transcaval coil embolizations (56%). Sac expansion was reported in 11 cases, out of 3 studies (17%). Only one case of death, not associated with transcaval embolization, was recorded.
CONCLUSIONS
Transcaval embolization for ET II treatment presents a high technical success and low mortality in the early and mid-term period. ET II persistence rate is low during the available 12-month follow-up.
背景
主动脉瘤血管内修复后持续的 II 型内漏（ET II）并不总是良性的，与囊腔扩张、破裂和再次干预有关。有多种不同的血管内方法可用于治疗 ET II。本系统评价的目的是评估目前关于经腔静脉栓塞治疗标准或复杂血管内主动脉瘤修复后 ET II 的文献。
方法
本系统评价方案已在 PROSPERO（CRD42021289686）上注册。遵循 PRISMA 指南和患者、干预、比较、结局（P.I.C.O.）模型。使用 PubMed、EMBASE 通过 Ovid 和 CENTRAL 数据库进行文献检索，检索时间截至 2021 年 9 月 30 日。仅纳入报道经血管内修复后使用经腔静脉途径治疗 ET II 栓塞的研究。排除报道不同类型内漏治疗或任何其他栓塞方法的研究。使用纽卡斯尔-渥太华量表评估研究质量。主要结局为技术成功和随访期间无 ET II 持续存在；次要结局为与经腔静脉栓塞相关的任何术后并发症和再次干预的需要。
结果
共检索到 2861 篇文章。纳入 8 篇文章，报道了 117 例患者和 128 例经腔静脉栓塞。治疗指征为囊腔扩张超过 5mm 的 ET II 存在；在两项研究中，存在持续内漏是干预的指征。技术成功率为 91.4%（117/128）；使用了各种栓塞材料，包括线圈、凝血酶和胶。记录了 3 例深静脉血栓形成，其余发病率和死亡率均为零。随访时间在 0 至 25 个月之间。在 8 项研究中，持续 ET II 率为 12.8%，进行了 18 次再次干预（14.1%），包括 10 次经腔静脉线圈栓塞（56%）。3 项研究中有 11 例报告囊腔扩张（17%）。仅记录到 1 例与经腔静脉栓塞无关的死亡病例。
结论
经腔静脉栓塞治疗 ET II 在早期和中期具有较高的技术成功率和低死亡率。在可获得的 12 个月随访期间，ET II 持续存在率较低。
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