腹主动脉瘤腔内修复术后内漏的发生及转归:单中心10年随访结果分析

Incidence and outcomes of endoleaks after endovascular aortic repair for abdominal aortic aneurysm: A single-center experience for 10 years

目的研究腹主动脉瘤(abdominal aortic aneurysm,AAA)患者行腹主动脉腔内修复术(endovascular aortic repair,EVAR)后内漏的发生情况及转归的趋势与规律。方法回顾性收集中山大学附属第一医院2013~2022年195例行常规EVAR术及EVAR+烟囱技术重建内脏动脉(chimney endovascular aortic repair,Ch-EVAR)后发生内漏的真性AAA患者临床资料,比较各型内漏的发生率,比较不同处理方式对内漏的预后有无影响。结果Ch-EVAR术后内漏发生率显著高于常规EVAR(46.4%vs 23.0%,P<0.001)。Ⅰa型、Ⅰb型、Ⅱ型、Ⅲ型和Ⅳ型内漏的发生率分别为13.3%、2.8%、5.5%、2.3%和1.8%。病例平均随访(35.5±25.8)个月,各型内漏在随访期内消失的比例分别为63.3%、73.9%、51.1%、57.9%和73.3%,经干预后内漏的转归与未干预内漏相比差异均无统计学意义(P均>0.05)。EVAR术后30d内死亡4例,其中1例为术后动脉瘤破裂;术后30d后死亡40例,其中4例与内漏相关。结论针对不同类型的内漏采取不同的处理方式,对瘤体持续增大和/或患者有症状的内漏进行积极干预,均能取得较为满意的结果。

Objective To investigate the trends and patterns in the incidence and outcomes of endoleaks in patients who underwent endovascular aortic repair(EVAR)for abdominal aortic aneurysm(AAA).Methods The clinical data of 195 cases who had endoleaks after EVAR or chimney endovascular aortic repair(Ch-EVAR)between 2013 and 2022 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.Incidence of various types of endoleaks were calculated and compared,and the effects of different management on the prognosis of endoleaks were also compared.Results The incidence rate of endoleak after Ch-EVAR was significantly higher than that after conventional EVAR(46.4%vs 23.0%,P<0.001).The incidence rates of typeⅠa,Ⅰb,Ⅱ,ⅢandⅣendoleaks were 13.3%,2.8%,5.5%,2.3%,and 1.8%,respectively.The mean follow-up period was 35.5±25.8 months.The percentages of corresponding types of endoleaks that disappeared during follow-up were 63.3%,73.9%,51.1%,57.9%,and 73.3%,respectively.There was no significant difference between the outcomes of endoleaks after intervention and that of endoleaks without indication for intervention(P>0.05).Four cases died within 30 days after EVAR,one of which was due to postoperative aneurysm rupture.40 cases died after 30 post-operative days of EVAR,four of which were related to endoleaks.Conclusion Adopting different treatment methods for different types of endoleaks and actively intervening in cases of continued aneurysm growth and/or symptomatic endoleaks can achieve satisfactory results.