腹主动脉瘤腔内修复术后II型内漏的处理
作者:
通讯作者:
作者单位:

中南大学湘雅医院 血管外科,湖南 长沙 410008

作者简介:

吴科敏,中南大学湘雅医院主治医师,主要从事周围血管疾病方面的研究。

基金项目:

湖南省长沙市自然科学基金资助项目(kq2014271)。


Management of type II endoleaks after endovascular abdominal aortic aneurysm repair
Author:
Affiliation:

Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    背景与目的 II型内漏是腹主动脉瘤腔内修复术(EVAR)术后相对常见的并发症,然而目前对其是否需要手术干预及干预时机方面尚无统一的认识。因此,本研究探讨EVAR术后II型内漏的手术方法,及其临床效果与安全性,以期为临床提供给参考。方法 回顾中南大学湘雅医院血管外科2016年1月—2020年12月期间行EVAR手术治疗的腹主动脉瘤患者临床与随访资料,分析EVAR术后发生II型内漏的发生率,以及其中行二次手术干预的患者的疗效、并发症及随访情况。结果 期间共282例行EVAR患者,术后随访1~54个月,平均17.9个月。随访过程中,发现单纯II型内漏68例(24.1%),其中31例患者(45.6%)II型内漏自愈;25例患者(36.8%)瘤体直径无明显增大;12例患者(17.6%)瘤体直径增加>10 mm或表现有相应的临床症状行二次干预。二次干预患者中,10例行经皮动脉栓塞术,其中8例患者行责任动脉栓塞者随诊12个月无内漏复发,瘤体直径缩小;2例栓塞后术后随访24个月II型内漏仍存在,但瘤体直径无继续增大;2例行开放手术,其中1例术后出现急性心肌梗死,行急诊PCI,术后顺利恢复出院,另1例术中大出血,住院时间延长至16 d。2例开放手术患者术后随访6个月以上,情况良好,内漏完全消失。结论 大部分EVAR术后II型内漏患者预后较好,而对于随访中瘤体直径增长较快及有临床症状者,栓塞责任血管可获得不错的临床效果;开放手术创伤相对较大,严重并发症发生率较高,选择需慎重。

    Abstract:

    Background and Aims Type II endoleak is a common complication after endovascular aortic aneurysm repair (EVAR). However, there is still no agreement on whether surgical intervention is required or the timing of intervention for this condition. Therefore, this study was conducted to evaluate the safety and efficacy of the surgical methods for type II endoleak after EVAR and their efficacy and safety, so as to provide information for clinical decision making.Methods The clinical and follow-up data of patients undergoing EVAR between January 2016 to December 2020 in Department of Vascular Surgery of Xiangya Hospital, Central South University were reviewed. The incidence of type II endoleak after EVAR as well as the efficacy, complications and follow-up results in those undergoing the second surgical intervention were analyzed.Results A total of 282 patients underwent EVAR during the study period. The follow-up was performed for 1 month to 54 months with an average of 17.9 months. During the follow-up, simple type II endoleak occurred in 68 patients (24.1%), in whom, the type II endoleak was spontaneously healed in 31 cases (45.6%), the aneurysmal diameter did not significantly increase in 25 cases (36.8%), and 12 cases (17.6%) underwent a second surgical intervention because the aortic aneurysm diameter increased >10 mm or relevant clinical symptoms were noted. In patients undergoing second surgical intervention, 10 patients underwent percutaneous arterial embolization, of whom 8 cases with embolization of the responsible artery were followed-up for 12 months and had no recurrence of endoleak with reduced aneurysmal diameter, and 2 cases undergoing embolization were follow-up 24 months and the type II endoleak was still visible, but the aneurysmal diameter did not increase; 2 patients underwent open surgery, of whom, 1 case had acute myocardial infarction after surgery, and emergency PCI was performed, and then was uneventfully recovered, and another case had a massive hemorrhage during surgery and the length of hospital was prolonged to 16 d. The 2 patients were followed up after open surgery for more than 6 months, and no further adverse events occurred and the endoleak completely disappeared.Conclusion Most patients with type II endoleak after EVAR have good prognosis. In those with rapid growth of aneurysmal diameter and clinical symptoms, the embolization of the responsible blood vessels can obtain good clinical results. Open surgery is a relatively traumatic procedure, with high incidence of serious complications, so the choice needs to be carefully considered.

    图1 弹簧圈栓塞患者资料 A:术前CTA;B:术后6个月CTA可见II型内漏来源于肠系膜下动脉;C:术中通过Riolan弓栓塞;D:术后28个月复查CTA,未见内漏,箭头处为弹簧圈Fig.1 Data of a patients undergoing coil embolization A: Preoperative CTA image; B: CTA showing the type II endoleak from the inferior mesenteric artery 6 months after surgery; C: Embolization of the endoleak through the arc of Riolan; D: CTA showing the endoleak disappear after 28 months, and the arrow showing the coils
    图2 Onyx胶水栓塞患者资料 A:术前CTA;B:术后6个月CTA可见II型内漏来源于肠系膜下动脉;C:内漏来源于肠系膜下动脉;D:术后6个月复查CTA,未见内漏,箭头处为Onyx胶水Fig.2 Data of a patients undergoing Onyx embolization A: Preoperative CTA image; B: CTA showing the type II endoleak from the inferior mesenteric artery 6 months after surgery; C: Embolization of the endoleak through the arc of Riolan; D: CTA showing the endoleak disappeared after 6 months, and the arrow showing Onyx
    图3 开放手术患者1资料 A:术前CTA;B:术后3个月CTA可见II型内漏来源于肠系膜下动脉,予以保守观察;C:术后45个月CTA可见瘤腔明显增大,合并右侧髂支闭塞;D-E:开放手术结扎内漏动脉(髂内动脉及肠系膜下动脉);F:开放手术后6个月复查CTA,未见内漏Fig.3 Data of case 1 of open surgery A: Preoperative CTA image; B: CTA showing the type II endoleak from the inferior mesenteric artery 3 months after surgery, and giving conservative therapy; C: CTA showing increased aneurysmal diameter and occlusion of the right iliac artery; D-E: Open surgery for ligation of responsible arteries (the internal iliac artery and the inferior mesenteric artery); F: CTA showing endoleak disappeared 6 months after open surgery
    图4 开放手术患者2资料 A:EVAR术后4年CTA;B:髂内巨大动脉瘤,II型内漏来源于髂内动脉;C:受压扩张的输尿管;D-E:开放手术结扎内漏动脉同时清除瘤体;F:开放手术后6个月复查CTA,未见内漏,输尿管梗阻解除Fig.4 Data of case 2 of open surgery A: CTA image 4 years after EVAR; B: CTA showing huge internal iliac artery aneurysm, and type II endoleak from internal iliac artery; C: CTA showing dilated ureter; D-E: Open surgery for ligation of internal iliac artery and thrombosis removal; F: CTA showing endoleak disappeared 6 months after open surgery
    参考文献
    相似文献
    引证文献
引用本文

吴科敏,周海洋,李瑶珍,王宪伟,欧阳洋,王伟,黄建华.腹主动脉瘤腔内修复术后II型内漏的处理[J].中国普通外科杂志,2021,30(12):1418-1426.
DOI:10.7659/j. issn.1005-6947.2021.12.005

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2021-09-27
  • 最后修改日期:2021-11-20
  • 录用日期:
  • 在线发布日期: 2022-01-07