Grandhomme Jonathan, Vakhitov Damir, Kuntz Salomé, Lejay Anne, Chakfé Nabil
Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
GEPROMED, Strasbourg, France.
EJVES Vasc Forum. 2024 Feb 3;61:81-84. doi: 10.1016/j.ejvsvf.2024.01.055. eCollection 2024.
To analyse case reports published on the latest generations of endograft (EG) and understand the mechanisms of type III endoleak (EL) development.
A literature review was undertaken of English language case reports and series that concerned modular junction or component disconnection (type IIIa EL) and fabric perforations (type IIIb EL) after endovascular aneurysm repair.
Of the 2 785 studies, 56 full texts were chosen to review 73 cases. Type III EL was diagnosed with computed tomography angiography in 67.1% and digital subtraction angiography in 12.3%; the rest were identified during surgery. Of the 73 EG, 65 (89.0%) were made of polyethylene terephthalate and seven (9.6%) were polytetrafluoroethylene. The type of material was not mentioned in one (1.4%) case report. There were 25 (34.2%) type IIIa and 48 (65.8%) type IIIb EL. The most frequent were trunk-trunk in nine (12.3%) and trunk-limb overlap separations in 14 (19.2%). Type IIIb EL in the trunk area was identified in 27 (37.0%) cases, while 21 (28.8%) defects were found in the limbs. Stent fractures were recognised as an underlying mechanism of type IIIb EL development in one report. A combination of fabric lesions in the trunk and limb area was found in one case. Seven type IIIb EL were related to suture disruption or suture-fabric abrasions. Four cases were related to stent-fabric abrasions, and two developed as a result of fabric fatigue owing to kinking. Information on the mechanisms of degradation was only occasionally and scarcely presented. Given the small number of reports and lack of detailed analysis, no definitive conclusions could be drawn.
The available information is scarce and does not allow any definitive conclusions to be drawn on the mechanisms that lead to the development of type III EL. Further explant analyses would be beneficial.
分析关于最新一代血管内移植物（EG）的病例报告，并了解III型内漏（EL）的发生机制。
对有关血管内动脉瘤修复术后模块化连接或部件分离（IIIa型EL）和织物穿孔（IIIb型EL）的英文病例报告及系列研究进行文献综述。
在2785项研究中，选择了56篇全文来回顾73例病例。67.1%的III型EL通过计算机断层扫描血管造影诊断，12.3%通过数字减影血管造影诊断；其余在手术中发现。在73个EG中，65个（89.0%）由聚对苯二甲酸乙二酯制成，7个（9.6%）由聚四氟乙烯制成。1份（1.4%）病例报告未提及材料类型。有25个（34.2%）IIIa型和48个（65.8%）IIIb型EL。最常见的是主干-主干分离9例（12.3%）和主干-分支重叠分离14例（19.2%）。躯干区域的IIIb型EL在27例（37.0%）病例中被发现，而肢体中有21处（28.8%）缺陷。在一份报告中，支架骨折被认为是IIIb型EL发生的潜在机制。在1例病例中发现躯干和肢体区域的织物损伤合并存在。7个IIIb型EL与缝线断裂或缝线-织物磨损有关。4例与支架-织物磨损有关，2例因扭结导致织物疲劳而发生。关于降解机制的信息只是偶尔且很少呈现。鉴于报告数量少且缺乏详细分析，无法得出明确结论。
现有信息稀缺，无法就导致III型EL发生的机制得出任何明确结论。进一步的取出物分析将是有益的。
