Erdemutu E, Zhou Chongbin, Ma Ming, Hu Liqiang, Wu Jisiguleng, Dai Xiangchen, Gao Zhanfeng
Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Department of Vascular Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
Front Cardiovasc Med. 2025 Apr 17;12:1450942. doi: 10.3389/fcvm.2025.1450942. eCollection 2025.
We aimed to analyze the risk factors associated with Type II endoleak (T2EL) requiring reintervention after endovascular aneurysm repair (EVAR) for multicenter abdominal aortic aneurysms.
A retrospective analysis was conducted on data from 614 patients with abdominal aortic aneurysms who underwent elective EVAR at three centers (Tianjin Medical University General Hospital, Affiliated Hospital of Inner Mongolia Medical University, Shanxi Provincial People's Hospital) from January 2017 to December 2021. After applying exclusion criteria, 375 patients were included in the study, with 50 patients in the T2EL-related reintervention group and 325 patients in the non-T2EL group. Single-factor and multiple-factor logistic analyses were used to identify high-risk factors, and ROC curve analysis was performed to determine the risk thresholds for mesenteric artery diameter, number of lumbar arteries, maximum aneurysm diameter, and proportion of intraluminal thrombus volume.
The rate of T2EL-related reintervention among the 375 patients was 13.33% (50/375). Single-factor analysis indicated that age, hypertension, maximum aneurysm diameter, proportion of intraluminal thrombus, diameter of inferior mesenteric artery (IMA), and number of patent lumbar arteries (LA) were risk factors for T2EL-related reintervention. Multiple-factor logistic analysis identified maximum aneurysm diameter, proportion of thrombus, IMA diameter, and number of patent LA as the main influencing factors for T2EL-related reintervention after EVAR. Significant risk factors for reintervention were maximum aneurysm diameter (OR = 1.043, 95% CI 1.015-1.072, = 0.002), IMA diameter (OR = 3.901, 95% CI 1.116-13.632, = 0.033), and number of LA (OR = 2.584, 95% CI 1.722-3.769, < 0.001). A significant protective factor for reintervention was thrombus proportion (OR = 0.895, 95% CI 0.864-0.927, < 0.001). ROC curve analysis showed that the risk thresholds for reintervention were an IMA diameter of 2.95 mm, intraluminal thrombus volume proportion <42.5%, number of LA ≤5.5, and aneurysm diameter of 53.55 mm.
Cases with identified risk factors are considered to have a higher risk of T2EL-related reintervention after EVAR. Exceeding the new risk thresholds may indicate a higher likelihood of T2EL-related reintervention after EVAR.
我们旨在分析多中心腹主动脉瘤血管内修复术（EVAR）后需要再次干预的Ⅱ型内漏（T2EL）相关危险因素。
对2017年1月至2021年12月在三个中心（天津医科大学总医院、内蒙古医科大学附属医院、山西省人民医院）接受择期EVAR的614例腹主动脉瘤患者的数据进行回顾性分析。应用排除标准后，375例患者纳入研究，其中T2EL相关再次干预组50例，非T2EL组325例。采用单因素和多因素logistic分析确定高危因素，并进行ROC曲线分析以确定肠系膜动脉直径、腰动脉数量、最大动脉瘤直径和腔内血栓体积比例的风险阈值。
375例患者中T2EL相关再次干预率为13.33%（50/375）。单因素分析表明，年龄、高血压、最大动脉瘤直径、腔内血栓比例、肠系膜下动脉（IMA）直径和通畅腰动脉（LA）数量是T2EL相关再次干预的危险因素。多因素logistic分析确定最大动脉瘤直径、血栓比例、IMA直径和通畅LA数量是EVAR后T2EL相关再次干预的主要影响因素。再次干预的显著危险因素为最大动脉瘤直径（OR = 1.043，95%CI 1.015 - 1.072，P = 0.002）、IMA直径（OR = 3.901，95%CI 1.116 - 13.632，P = 0.033）和LA数量（OR = 2.584，95%CI 1.722 - 3.769，P < 0.001）。再次干预的显著保护因素为血栓比例（OR = 0.895，95%CI 0.864 - 0.927，P < 0.001）。ROC曲线分析显示，再次干预的风险阈值为IMA直径2.95 mm、腔内血栓体积比例<42.5%、LA数量≤5.5和动脉瘤直径53.55 mm。
具有已确定危险因素的病例被认为在EVAR后发生T2EL相关再次干预的风险较高。超过新的风险阈值可能表明EVAR后发生T2EL相关再次干预的可能性较高。
