Onitsuka Seiji, Ito Hiroyuki
Department of Surgery, Kurume University, Kurume, Fukuoka, Japan.
Department of Vascular Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Fukuoka, Japan.
Ann Vasc Dis. 2023 Mar 25;16(1):1-7. doi: 10.3400/avd.ra.22-00115.
An aneurysm sac enlargement caused by type II endoleak (T2EL) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms may cause serious complications such as rupture. Consequently, methods that preoperatively prevent or postoperatively treat T2EL have been employed. When significant aneurysm enlargement occurs due to persistent T2EL, embolization is first performed through several access points. However, although these endovascular reinterventions have a high technical success rate and are safe, their effectiveness remains questionable. When such endovascular procedures fail to stabilize sac enlargement, open surgical conversion (OSC) becomes the last-resort treatment option. We review several strategies of OSC for the repair of T2EL following EVAR. Among the three main OSC procedures, namely, complete endograft removal, partial endograft removal, and complete endograft preservation, partial endograft removal under infrarenal clamping was considered the most appropriate owing to its less invasiveness and durability.
腹主动脉瘤血管内修复术（EVAR）后由II型内漏（T2EL）引起的动脉瘤囊扩大可能导致破裂等严重并发症。因此，已采用术前预防或术后治疗T2EL的方法。当由于持续性T2EL导致动脉瘤显著扩大时，首先通过多个入路点进行栓塞。然而，尽管这些血管内再次干预技术成功率高且安全，但其有效性仍值得怀疑。当此类血管内手术未能稳定瘤囊扩大时，开放手术转换（OSC）成为最后的治疗选择。我们回顾了几种用于修复EVAR后T2EL的OSC策略。在三种主要的OSC手术中，即完全移除腔内移植物、部分移除腔内移植物和完全保留腔内移植物，肾下钳夹下部分移除腔内移植物因其侵袭性较小和耐久性而被认为是最合适的。
