Kim Min-Kyu, Park Yang-Jin, Yang Shin-Seok, Kim Dong-Ik, Kim Jun-Gon, Hyun Dong-Ho, Park Kwang-Bo, Do Young-Soo, Kim Young-Wook
Division of Vascular Surgery, Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea.
Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2024 Mar;106(3):178-187. doi: 10.4174/astr.2024.106.3.178. Epub 2024 Feb 22.
Type 2 endoleaks (T2EL) are the most common form of endoleaks after endovascular aneurysm repair (EVAR). Several studies on the feasibility of embolization using ethylene vinyl alcohol copolymer (Onyx, Medtronic) for T2EL have been reported. The purpose of this study was to compare coil and Onyx embolization for T2EL treatment after EVAR.
Between August 2005 and July 2022, 46 patients underwent endovascular embolization for treatment of T2EL (15 Onyx and 31 coils). The primary endpoint was endoleaks resolution or significant aneurysm sac growth of >5 mm in maximal diameter after T2EL embolization. In addition, periprocedural factors, reintervention, sac rupture, and survival analysis were assessed.
The follow-up period after embolization was significantly shorter in the Onyx group (11.6 months 34.7 months, P = 0.016), and there was no difference in aneurysm sac growth rate between both groups (20.0% 51.6%; P = 0.472, log-rank test). However, cases with multiple endoleak origins tended to be treated with Onyx (P = 0.002). When applying Onyx, there was no significant difference in results between the transarterial and translumbar approaches.
There appears to be no significant difference in the results of Onyx and coil embolization for T2EL treatment, although it is difficult to evaluate effectiveness due to the small number of cases and short follow-up period. However, in cases of multiple origin endoleaks or when the transarterial approach is not feasible, the Onyx by translumbar approach may be a more effective method.
2型内漏（T2EL）是血管内动脉瘤修复术（EVAR）后最常见的内漏形式。已有多项关于使用乙烯-乙烯醇共聚物（美敦力公司的Onyx）栓塞治疗T2EL可行性的研究报道。本研究的目的是比较使用弹簧圈和Onyx栓塞治疗EVAR术后T2EL的效果。
2005年8月至2022年7月期间，46例患者接受了血管内栓塞治疗T2EL（15例使用Onyx，31例使用弹簧圈）。主要终点是T2EL栓塞术后内漏消失或动脉瘤囊最大直径显著增大>5mm。此外，还评估了围手术期因素、再次干预、囊破裂和生存分析情况。
Onyx组栓塞后的随访期明显较短（11.6个月对34.7个月，P = 0.016），两组间动脉瘤囊生长率无差异（20.0%对51.6%；P = 0.472，对数秩检验）。然而，多个内漏起源的病例倾向于使用Onyx治疗（P = 0.002）。应用Onyx时，经动脉途径和经腰途径的结果无显著差异。
尽管由于病例数量少和随访期短难以评估疗效，但Onyx和弹簧圈栓塞治疗T2EL的结果似乎无显著差异。然而，对于多个起源的内漏病例或经动脉途径不可行时，经腰途径使用Onyx可能是一种更有效的方法。
