血管内动脉瘤修复前常规肠系膜下动脉栓塞术是不必要的。
Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair.
机构信息
Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland.
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
出版信息
Eur J Vasc Endovasc Surg. 2023 Feb;65(2):264-270. doi: 10.1016/j.ejvs.2022.11.009. Epub 2022 Nov 9.
OBJECTIVE
A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B).
METHODS
Patients were treated with EVAR in two centres during the period 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates.
RESULTS
Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively.
CONCLUSION
The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.
目的
在血管内动脉瘤修复（EVAR）后监测期间，II 型内漏是最常见的并发症，而通畅的肠系膜下动脉（IMA）是内漏的已知危险因素。在 EVAR 之前常规进行 IMA 栓塞对整体结果的影响尚不清楚。本研究的目的是比较两种策略：在 EVAR 之前常规尝试 IMA 栓塞（中心 A 的策略）和不干预 IMA（中心 B 的策略）。
方法
在 2005 年至 2015 年期间，两个中心的患者接受了 EVAR 治疗，回顾性审查了数据。主要终点是由于 II 型内漏导致的再干预率和晚期 IMA 栓塞率。次要终点包括 EVAR 相关的再干预、囊腔增大、动脉瘤破裂和开放转换率。
结果
A 策略用于治疗 395 例患者。IMA 在 268 例（67.8%）患者中是通畅的，164 例（41.5%）进行了栓塞。B 策略的相应数据为 337 例患者，279 例（82.8%）IMA 通畅，其中 2 例（0.6%）进行了栓塞。A 策略的平均随访时间为 70 个月，B 策略为 68.2 个月。由于 II 型内漏导致的再干预率分别为 12.9%和 10.4%（p=0.29），通畅的 IMA 进行栓塞的再干预率也没有显著差异（分别为 2.0%和 4.7%；p=0.039）。EVAR 相关的再干预率也相似，与策略无关（分别为 24.1%和 24.6%；p=0.93）。A 策略治疗的病例中有 20.3%出现显著的囊腔增大，B 策略治疗的病例中有 19.6%出现显著的囊腔增大（p=0.82）。破裂和转换率分别为 2.5%和 2.1%（p=0.69）和 1.0%和 1.5%（p=0.40）。
结论
常规栓塞 IMA 的策略似乎没有带来任何显著的临床获益，因此应该被放弃。
Zotero 插件