瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效分析

Aortic banding for refractory endoleaks after endovascular abdominal aortic aneurysm repair

目的总结瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效。方法回顾性分析2019年6月至2022年4月北京大学人民医院10例行瘤颈捆扎手术患者的临床及随访资料。结果手术指征为术后持续Ⅰ型内漏6例、Ⅱ型内漏3例、存在内张力1例,均合并动脉瘤增大或破裂。全麻下经腹入路套带控制肾下近端瘤颈后使用捆扎带进行加固。10例患者均获得手术成功,无内漏残留,无支架移植物闭塞。围手术期并发症包括1例伤口愈合延迟和1例不完全性肠梗阻,无围手术期死亡。中位随访时间13个月,未发现内漏复发。1例患者术后6个月因胸降主动脉瘤接受胸主动脉瘤腔内修复术;无其他主动脉相关二次手术或主动脉相关死亡。结论瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏相对微创,可以有效消除内漏。

Objective To summarize the safety and efficacy of aortic banding in the treatment of refractory endoleaks after endovascular abdominal aortic aneurysm repair(EVAR).Methods The clinical and follow-up data of 10 patients with refractory endoleaks EVAR undergoing aortic banding at Peking University People's Hospital from Jun 2019 to Aprl 2022 were retrospectively analyzed.Results The aortic banding was indicated for typeⅠendoleak in 6 patients,typeⅡendoleak in 3 patients and internal tension in 1 patient with persistent aneurysm enlargement or rupture.The surgical procedure was based on laparotomy.The proximal aortic neck was exposed and re-fixation with artificial strip to prevent bleeding.The surgical procedures was successful in all the 10 cases without residual endoleak or re-bleeding.The post-operative contrast-enhanced ultrasonography revealed neither new-onset endoleak nor occlusion of stent-grafts.Perioperative complications included one case of delayed wound healing and one case of incomplete ileus.No perioperative deaths occurred.Midterm follow-up was achieved in 10 patients with a mean follow-up time of 13 months.No recurrence of endoleak was found.One patient underwent endovascular repair for independent thoracic aortic aneurysm 6 months after surgery.There were no other aorta-related secondary surgeries or aortic-related deaths.Conclusion Aortic banding for refractory endoleaks after EVAR is minimally invasive and reliable.It can effectively eliminate the refractory endoleaks,and reduce the risks of aortic-related secondary surgery or death.