腹主动脉瘤（AAA）腔内修复术（EVAR）是目前大动脉病变腔内治疗最成熟的技术之一。AAA EVAR术后内漏指支架型血管置入后，在支架型血管腔外、被旷置的瘤体及邻近血管腔内出现持续性血流的现象［1~3］。内漏是AAA EVAR术后最为常见、对疗效影响很大的并发症，其发生率大约15%～50%［4］。内漏可导致瘤体进一步增大甚至破裂。目前，内漏的机理尚不完全明确，诊断与治疗方面也存在争议。现根据我院临床经验，结合近年来相关文献报道探讨AAA EVAR术后内漏的诊治。......
Objective To investigate the technical feasibility and effectiveness of intraoperative sac embolizaion with coils and fibrin glue for preventing type Ⅱ endoleak after endovascular aneurysm repair (EVAR). Methods A patient with abdominal aortic aneurysm (AAA), which had high risk of type Ⅱ endoleaks, was treated with combined packing of coils and fibrin glue in order to prevent type Ⅱ endoleak after EVAR. Percutaneous catheter preset and balloon occlusion were used to ensure accurate packing. Results At the end of the operation, the angiography showed that the blood flow of the stent and distal artery was unobstructed, there was no type Ⅰ and Ⅲ endoleaks, and delayed angiogram showed no collateral circulation of aneurysm. The procedure was successful. The operative duration was 120 min and the blood loss was only 20 mL. No complications such as colonic ischemia and ectopic embolism occurred, and the patient was discharged on 3 days after operation. At 6 months after follow-up, the computerized topographic angiography showed that the aneurysm cavity was completely thrombotic, without type II endoleak, and the diameter and volume of aneurysm were reduced. Conclusions The technique of intraoperative sac embolizaion with coils and fibrin glue during EVAR is safe and effective to prevent postoperative endoleaks, which is simple and feasibility. Intraoperative indwelling catheter and balloon blocking are the key points of successful implementation of this technique.
Objective To retrospectively review our experience of correction of type Ⅰa endoleak after thoracic endovascular aortic repair(TEVAR). Methods From August 2009 to May 2016, 29 patients with type Ⅰa endoleak after TEVAR (25 males, 4 females at mean age of 56±10 years (range, 41–86 years) underwent treatment: open surgery in 15 patients (an open surgery group), hybrid aortic arch repair in 6 patients (a hybrid group) and cuff extension in 8 patients(a cuff group). A history of hypertension was noted in 25 patients, diabetes mellitus in 3 patients, coronary artery disease in 3 patients, lung infection in one patient, aortic root aneurysm in one patient and aberrant right subclavian artery in one patient. Results In the open surgery group, no death was observed. Continuous renal replacement therapy and re-intubation was done in one patient and drainage of pericardial effusion in one patient. No death was noted in the hybrid group and persistent type Ⅰa endoleak in one patient. In the cuff group, thrombosis of the left common artery was noted in one patient and bypass of the left axillary artery to the left axillary artery and the left common carotid artery was done. Unfortunately, he died of cerebral infarction and total in-hospital death rate was 3.4% (1/29). Bypass of the left axillary artery to the left axillary artery was done in one patient with left upper limb ischemia. There were 4 (14.2%) deaths during follow-up: 3 deaths in the open surgical group and one death in the cuff group. Endoleak was observed in one patient in the hybrid group and one in the cuff group. Conclusion The corresponding procedure, including open surgery, hybrid aortic arch repair or cuff extension, is scheduled to be done according to the characteristics of type Ⅰa endoleak. Satisfactory outcomes are achieved in patients with typeⅠa endoleak.
腔内隔绝术（endovascular exclusion, EVE）最早用于治疗腹主动脉瘤，1994年Dake报道将其用于B型主动脉夹层（aortic dissection, AD）的治疗，国内自1998年开展。在EVE治疗AD的10余年历史中，内漏的预防和处理始终是一个备受关注的问题，现结合笔者的经验讨论AD术后内漏相关的问题。......
Objective To investigate the management experience of type Ⅱ endoleak originating from inferior mesenteric artery (IMA) after endovascular abdominal aortic aneurysm repair (EVAR). Methods The clinical data of patients with type Ⅱ endoleak originating from IMA after EVAR treated in the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from October 2016 to November 2021 were collected and analyzed. Results There were 12 males and 3 females at age of 57-89 (68.00±7.84) years. Eleven patients received embolization of the abdominal aortic aneurysm lumen and initial segment of the IMA via the superior mesenteric artery-middle colic artery-Riolan arch-left colic artery-IMA route. Three patients received embolization of the initial segment of the IMA by the above route. One patient underwent open dissection of the abdominal aortic aneurysm, and orifice of IMA was sutured in the aneurysm cavity while stents were retained. All 15 patients were successfully treated by surgery. The symptoms of back pain, abdominal pain and abdominal distension disappeared in 6 patients after surgery. Neither perioperative deaths nor complications happened during the treatment and follow-up period. The median follow-up time was 11.00 (9.00, 18.00) months. Two patients with typeⅡendoleak recurred during the follow-up period and were admitted to hospital for secondary embolization. No recurrence was observed at 12 months postoperative follow-up. Conclusion Type Ⅱ endoleak is one of the most common complications after EVAR. IMA is the most common criminal origin of typeⅡendoleak. TypeⅡendoleak that lead to persistent expansion of the aneurysm cavity requires aggressive intervention.
ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
Objective To review and compare the literatures on studying endoleak via intra-sac pressure (Psac) measurement in order to reveal the characters of all types of endoleak. Methods Measured the intra-sac pressure with miscellaneous pressure transducers in vitro and in vivo endoleak models or patients afflicted with endoleak. Compared the difference of Psac among no endoleak and all types of endoleak. Results Psac＞0 but was obviously lower than Psys in no endoleak. Psac approached Psys in type Ⅰ and type Ⅳ endoleaks. Some researches showed that Psac in type Ⅱ endoleak was higher than that in no endoleak and even approached Psys, however the other researches showed that Psac in type Ⅱ endoleak was lower than that in no endoleak. Conclusion Postoperative Psac dropping greatly eliminated the risk of aneurysm rupture, which symbolized the success of endovascular therapy. Even if the type Ⅰ endoleak of small size might lead to obvious elevation of Psac, which necessitates management. The impairment and management tactics of type Ⅱ endoleak remained equivocal, which required further study.
ObjectiveTo determine the influence of proximal aneurysm neck anatomy on typeⅠA endoleak follo-wing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm. MethodsFrom September 2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR. The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of typeⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. ResultsThe recurrence of typeⅠA endo-leak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren't related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. ConclusionsThe complicated proximal aneurysm neck anatomy is a major cause for the typeⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The applica-tion of EVAR depends largely on the shape of the proximal aneurysm neck.
ObjectiveTo discuss the risk factors of type Ⅱ endoleak after endovascular aneurysm repair(EVAR). MethodsThe clinical data of 197 cases of abdominal aortic aneurysm who underwent EVAR in our hospital from Jan. 2006 to Mar. 2011 were analyzed retrospectively, and risk factors of type Ⅱ endoleak were explored by logistic regression. ResultsOf the 197 cases, 18 cases suffered from type Ⅱ endoleak. Result of logistic regression showed that the risk of type Ⅱ endoleak increased per 1 of the increase of lumbar artery number(OR=1.822, P=0.010) and per 1 mm of the increase of lumbar artery diameter(OR=1.256, P=0.040). All of the cases were followed up for 1-36 months(median value of 16.8 months). Only 1 case was intervened by inferior mesenteric artery embolism for the growth rate larger than 5 mm during half a year, who was not found growth of diameter after the embolism. The type Ⅱ endoleaks of other 17 cases closed ultimately or keeping stable. ConclusionsType Ⅱ endoleak after EVAR is affected by the number and diameter of lumbar artery. Persistent type Ⅱ endoleak without enlargement of diameter of aneurysm sac needs to beclosely followed-up instead of re-intervention.