腹主动脉瘤腔内修复术后Ⅱ型内漏发生的危险因素分析及其处理

Risk Factors Analysis of Type Ⅱ Endoleak after Endovascular Aneurysm Repair

目的 探讨腹主动脉瘤（AAA）腔内修复（EVAR）术后Ⅱ型内漏发生的影响因素。方法 回顾性分析2006年1月至2011年3月期间四川大学华西医院血管外科行EVAR术的197例AAA患者的临床资料，并探讨Ⅱ型内漏发生的影响因素。结果 197例患者行EVAR后发生Ⅱ型内漏18例。logistic回归分析结果显示，腰动脉数量每增加１根，发生Ⅱ型内漏的风险增加了0.822倍（OR=1.822，P=0.010）；最大腰动脉直径每增加1 mm，发生Ⅱ型内漏的风险增加了0.256倍（OR=1.256，P=0.040）。197例患者获访1～36个月，中位数为16.8个月。随访期间，1例瘤体直径于术后6个月时增长大于5 mm，给予经股动脉以弹簧圈栓塞肠系膜下动脉分支处理，术后内漏消失；余17患者的内漏自行封闭或瘤体直径无明显变化。结论 腰动脉数量和最大腰动脉直径均可影响Ⅱ型内漏的发生。如果持续性Ⅱ型内漏的瘤体直径无明显变化，可暂不处理，但应密切随访。

Objective To discuss the risk factors of type Ⅱ endoleak after endovascular aneurysm repair （EVAR）. Methods The 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 typeⅡ endoleak were explored by logistic regression. Results Of the 197 cases, 18 cases suffered from typeⅡ endoleak. Result of logistic regression showed that the risk of typeⅡ 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 typeⅡ endoleaks of other 17 cases closed ultimately or keeping stable. Conclusions TypeⅡ endoleak after EVAR is affected by the number and diameter of lumbar artery. Persistent typeⅡ endoleak without enlargement of diameter of aneurysm sac needs to beclosely followed-up instead of re-intervention.