Ushijima Yasuhiro, Asayama Yoshiki, Nishie Akihiro, Ishigami Kousei, Takayama Yukihisa, Okamoto Daisuke, Fujita Nobuhiro, Morita Koichiro, Honda Hiroshi
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Interv Radiol (Higashimatsuyama). 2019 Nov 1;5(1):1-9. doi: 10.22575/interventionalradiology.2018-0018. eCollection 2020 Feb 28.
To elucidate the safety and efficacy of embolization using N-butyl cyanoacrylate (NBCA) for endoleaks after abdominal/thoracic endovascular aortic repair (EVAR/TEVAR) via a direct percutaneous approach versus a transarterial approach.
The retrospective design of the study was approved by the institutional ethics committee, and the requirement for informed written consent was waived. Sixteen patients underwent embolization for endoleaks after EVAR/TEVAR, which was diagnosed as type II, from March 2010 to December 2013 at our institution. The number of embolization sessions was 21. A direct percutaneous approach was used in 10 sessions, and a transarterial approach was used in 11 sessions. There were 11 and 15 embolic sites for the two approaches, respectively. The procedure time, amount of contrast media used, therapeutic effect, and complications were evaluated.
The mean procedure time (per embolic site) was 100 min (53-170) in the direct percutaneous approach, which was significantly shorter than the 191 min (76-275) in the transarterial approach. The mean amount of contrast media used during the procedure (per embolic site) was 12.8 ml (3-25) by the direct percutaneous approach, which was significantly lesser than the 71.8 ml (30-180) in the transarterial approach. Local control of the embolic site and interval increase in the size of aneurysm after embolization were not significantly different between the two approaches. In one case each, mesenteric hematoma and migration of the embolic agent occurred with a direct percutaneous approach, and a small arterial injury occurred with the transarterial approach; aneurysmal rupture/perianeurysmal hematoma and neurological dysfunction were not observed.
A direct percutaneous approach is a feasible procedure for embolization of endoleaks after EVAR/TEVAR.
阐明经皮直接入路与经动脉入路使用氰基丙烯酸正丁酯（NBCA）栓塞腹/胸主动脉腔内修复术（EVAR/TEVAR）后内漏的安全性和有效性。
本研究的回顾性设计经机构伦理委员会批准，无需知情书面同意。2010年3月至2013年12月，我院16例接受EVAR/TEVAR术后内漏栓塞治疗的患者被诊断为Ⅱ型内漏。栓塞次数为21次。10次采用经皮直接入路，11次采用经动脉入路。两种入路的栓塞部位分别为11个和15个。评估手术时间、造影剂用量、治疗效果及并发症。
经皮直接入路平均手术时间（每个栓塞部位）为100分钟（53 - 170分钟），明显短于经动脉入路的191分钟（76 - 275分钟）。经皮直接入路术中平均造影剂用量（每个栓塞部位）为12.8毫升（3 - 25毫升），明显少于经动脉入路的71.8毫升（30 - 180毫升）。两种入路在栓塞部位的局部控制及栓塞后动脉瘤大小的间隔增加方面无显著差异。经皮直接入路各有1例发生肠系膜血肿和栓塞剂迁移，经动脉入路有1例发生小动脉损伤；未观察到动脉瘤破裂/瘤周血肿及神经功能障碍。
经皮直接入路是EVAR/TEVAR术后内漏栓塞的一种可行方法。
