腹主动脉瘤腔内修复术后Ⅱ型内漏的诊断和治疗  

The diagnosis and treatment of type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair

作　　者：寇镭[1] 陈忠[1] 唐小斌[1] 吴章敏[1] 刘晖[1] 杨耀国[1] 王盛[1] 刘硕[1] 吴庆华[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所血管外科,100029

出　　处：《心肺血管病杂志》2016年第11期875-879,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨腹主动脉瘤腔内修复术（EVAR）术后单纯Ⅱ型内漏的诊断和治疗方式。方法：回顾性分析2002年1月至2016年4月北京安贞医院血管外科EVAR术后治疗Ⅱ型内漏的发病率、诊断方法、随诊情况以及干预治疗措施。结果：本组EVAR术后发现单纯Ⅱ型内漏36例,发生率10.84%;21例（58.3%）为术后即刻动脉造影显示Ⅱ型内漏存在,另15例（41.7%）EVAR术后即刻动脉造影未发现内漏,随访过程中发现Ⅱ型内漏存在。随访时间3~118个月,平均随访时间17.9个月。Ⅱ型内漏自愈率为47.2%（17/36）。随诊过程中瘤体直径无明显增大27.8%（10/36）。失访率13.9%（5/36）。4例Ⅱ型内漏因瘤体直径增加〉10mm给予经动脉途径弹簧圈栓塞术治疗,二次干预治疗率11.1%（4/36）;术中即刻动脉造影Ⅱ型内漏均消失,技术成功率100%。其中2例靶动脉栓塞者随诊12个月无内漏复发,瘤体直径缩小;1例髂内动脉和瘤腔内栓塞,术后复查CTA提示Ⅱ型内漏存在,瘤体直径较栓塞术前缩小3mm,栓塞术后随访21个月Ⅱ型内漏仍存在,瘤体直径无继续增大;1例瘤腔栓塞术后10个月发现Ⅱ型内漏复发且瘤体直径增大10mm,栓塞术后15个月动脉瘤破裂,急诊行腹主动脉瘤切除、腹主动脉至双侧髂总动脉人工血管间置移植术成功,术中确诊为腰动脉来源导致Ⅱ型内漏;目前开腹术后随访6个月患者情况良好。结论：EVAR术后Ⅱ型内漏是比较常见的并发症,在中、远期随访中Ⅱ型内漏的出现甚至导致瘤体直径增加并不少见,甚至可以导致破裂。因此对于EVAR术后严密随访十分重要,尤其对于瘤体直径增大者。应用支撑导管行经动脉途径栓塞术,有助于到达靶动脉开口部位。应用弹簧圈进行靶动脉开口部位确切栓塞可能会降低Ⅱ型内漏的复发率,且安全。其远期疗效有待于更长时间的随访和更多的病例积累。Objective： The aim was to discuss the diagnosis and treatment of type Ⅱ endoleak after endovascular abdominal aortic aneurysm repair（ EVAR）. Methods： The retrospective analyses were performed for the cases with isolate type Ⅱ endoleak after EVAR from the vascular department of Beijing Anzhen Hospital,from Jan,2002 to Apr,2016. Results： There are 36 cases isolate type Ⅱ endoleak occurred over a range of 3-118 months of follow-up in 332 patients post EVAR（ 10. 8%）,21 cases（ 58. 3%） were diagnosed by aortic arteriography during EVAR and 15cases（ 41. 7%） were diagnosed by computed tomography angiogram（ CTA） and ultrasonography（ US） imaging during follow-up. 17 cases of type Ⅱ endoleak（ 47. 2%） demonstrated spontaneous resolution. 10 cases（ 27. 8%） with persistent type Ⅱ endoleak were freedom from sac expansion or rupture. 5 cases（ 13. 9%） of all were losing follow-up. The transarterial embolization were performed in 4 cases（ 11. 1%） with aneurysm sac growth ≥ 10 mm. Technical success were achieved in all procedures. Sac decreasing or stable were found in 2 cases without recurrent endoleaks during 12 months follow-up post Transarterial embolotherapy which the feeding arteries embolization were performed. In this cohort,1 case recurrent type Ⅱ endoleak were diagnosed by CTA and US post left internal iliac artery and sac embolization,while the aneurysm sac was stable during 21 months follow-up post embolotherapy. Unfortunately,1 case developed rupture post 15 months of sac embolization which recurrent type Ⅱ endoleak occurred at 10 months post procedure. Open surgery was performed for this case successfully. Conclusion： Type Ⅱ endoleaks are more common complications post EVAR that can be observed during middle and long-term follow-up. The sac expansions were not rare due to persistent type Ⅱ endoleaks,while the adverse late outcomes were rupture. Transarterial embolotherapy with support catheters maybe conducive to access the feeding arteries of endolea

关 键 词：腹主动脉瘤腔内修复术 Ⅱ型内漏 栓塞术 

分 类 号：R54[医药卫生—心血管疾病]