腹主动脉瘤腔内修复术后短期内漏分析

ANALYSIS OF ENDOLEAK IN SHORT TERM AFTER ENDOVASCULAR ANEURYSM REPAIR FOR ABDOMINAL AORTIC ANEURYSMS

目的总结腹主动脉瘤（abdominal aorta aneurysm，AAA）患者腔内修复术（endovascular aneurysmrepair，EVAR）术后短期内漏发生情况，分析内漏产生原因。方法2005年7月一2013年6月，采用EVAR治疗210例AAA患者。男175例，女35例；年龄42～89岁，平均65．7岁。通过计算机断层扫描动脉造影（computed tomographyangiography，CTA）证实为。肾下型AAA患者。病程1周～2年，中位病程11．3周。动脉瘤最大直径44～72mm，平均57．3mm；锚定区长度均〉1．5cm。术后2个月常规行CTA复查，了解造影剂内漏情况；如有较明显内漏，于术后6个月再次复查CTA；如仍有明显内漏，行数字剪影血管造影（digitalsubtractionangiography，DSA），进一步明确内漏性质及程度，必要时采用EVAR修复。结果术中31例患者（14．8％）支架人工血管发生内漏，其中I型内漏11例（IA型8例、IB型3例），II型内漏18例，III型内漏2例（均为IIIB型）。患者均获随访，随访时间2～8个月，平均3．1个月。术后2个月复查12例（5．7％）残余动脉瘤腔内有明显造影剂内漏。术后6个月复查仍有10例（4．8％）存在明显内漏，其中8例患者行DSA检查，发现I型4例（IA型3例、IB型1例），II型3例，III型1例。5例I、III型患者均有不同程度支架人工血管侧突，采用增加延伸移植物支架人工血管方式处理，2～4个月后再次复查CTA显示内漏均消失；II型患者未作特殊处理，2个月后再次复查CTA显示内漏仍存在，但动脉瘤最大直径无明显增大。结论支架人工血管侧突是AAA患者EVAR术后短期I、III型内漏产生的重要原因，可通过再次EVAR封堵内漏。

Objective To observe the occurrence condition of endoleak after endovascular aneurysm repair （EVAR） operation for abdominal aortic aneurysm （K4A）, and to analyze the factors of the endoleak. Methods Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years （mean, 65.7 years）. The patients were all proved to have infrarenal AAA by computed tomography angiography （CTA）. The disease duration ranged from 1 week to 2 years （median, 11.3 weeks）. The maximum diameter of the aneurysms was 44-72 mm （mean, 57.3 mm）. The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography （DSA） would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary. Results Endoleak occurred in 31 cases （14.8%） during operation, including 11 cases of type I endoleak （8 cases of type IA and 3 cases of type IB）, 18 cases of type II endoleak, and 2 cases of type Ill endoleak （type IIIB）. The patients were followed up 2-8 months （mean, 3.1 months）. At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases （5.7%）. At 6 months after eperation, contrast agent endoleak was found in 10 cases （4.8%） by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak （3 cases of type IA and 1 case of type IB）, 3 cases of type II endoleak, and 1 case of type III （type IIIB） endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement. Conclusion The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.