Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US.
Methodist Debakey Cardiovasc J. 2023 Mar 7;19(2):38-48. doi: 10.14797/mdcvj.1176. eCollection 2023.
Type 2 endoleaks remain the Achilles heel of abdominal aortic endografting. They drive imaging costs and repeat intervention. We believe that after two endovascular interventions, patients should be considered for either graft explantation or graft salvage through an open abdominal exploration. Graft explantation has been associated with increased morbidity and mortality but remains necessary in the face of non-correctible type 1a endoleaks, graft failure, or graft infection. In the majority of cases AAA expansion due to persistent type 2 endoleak is the culprit. In this situation, open repair, with oversewing of the lumbar or inferior mesenteric arteries, can be accomplished providing the seal zones and component overall zones are adequate. This approach does not require aortic clamping. We provide detailed descriptions and videos to facilitate the surgeon in performing these complex procedures.
2 型内漏仍然是腹主动脉瘤腔内修复术的阿喀琉斯之踵。它们导致了影像学检查费用的增加和重复介入。我们认为，在进行了两次血管内介入治疗后，对于那些存在 1a 型不可矫正内漏、移植物失败或移植物感染的患者，应考虑进行移植物取出或通过开放腹部探查进行移植物挽救。虽然移植物取出术与更高的发病率和死亡率相关，但在面对不可矫正的 1a 型内漏、移植物失败或移植物感染时，这仍然是必要的。在大多数情况下，由于持续的 2 型内漏导致 AAA 扩张是罪魁祸首。在这种情况下，可以进行开放修复，缝合腰动脉或肠系膜下动脉，只要密封区域和整体区域足够。这种方法不需要主动脉夹闭。我们提供详细的描述和视频，以帮助外科医生进行这些复杂的手术。
