腹主动脉瘤腔内修复术后肠系膜下动脉来源Ⅱ型内漏的单中心回顾性分析

TypeⅡendoleak originating from inferior mesenteric artery after endovascular abdominal aortic aneurysm repair:A retrospective analysis in a single center

目的探讨腹主动脉瘤腔内修复术后肠系膜下动脉来源Ⅱ型内漏的处理经验。方法回顾性分析山东第一医科大学附属省立医院血管外科2016年10月—2021年11月腹主动脉瘤腔内修复术后肠系膜下动脉来源Ⅱ型内漏患者的临床资料。结果共纳入15例患者,男12例、女3例,年龄57~89(68.00±7.84)岁。11例患者经肠系膜上动脉-中结肠动脉-Riolan弓-左结肠动脉-肠系膜下动脉途径栓塞腹主动脉瘤瘤腔和肠系膜下动脉起始段。3例患者经上述途径栓塞肠系膜下动脉起始段。1例行开腹剖开瘤体,瘤腔内缝扎肠系膜下动脉后并保留支架。15例患者均成功实施手术,6例患者术后腰痛、腹痛、腹胀等症状消失,无围手术期死亡或并发症。出院后随访中位时间11.00(9.00,18.00)个月,随访期内2例患者Ⅱ型内漏复发,入院行二次栓塞治疗,术后随访12个月未见复发。结论Ⅱ型内漏是腹主动脉瘤腔内修复术后常见的并发症,其中肠系膜下动脉来源最为多见。导致瘤腔持续扩张的Ⅱ型内漏需积极干预。

Objective To investigate the management experience of typeⅡendoleak originating from inferior mesenteric artery(IMA)after endovascular abdominal aortic aneurysm repair(EVAR).Methods The clinical data of patients with typeⅡendoleak 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 followup 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 TypeⅡendoleak 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.