腹主动脉瘤腔内修复术中栓塞肠系膜下动脉和腰动脉预防Ⅱ型内漏的临床意义及研究进展  

Embolization of the inferior mesenteric artery and lumbar arteries during endovascular aortic repair for the prevention of type II endoleak:clinical significance and research

作　　者：谭程鹏 容丹 刘浩 张子涵 何健 姜鹏 崔永攀 梅菲 TAN Chengpeng;RONG Dan;LIU Hao;ZHANG Zihan;HE Jian;JIANG Peng;CUI Yongpan;MEI Fei(Department of Vascular Surgery,the First College of Clinical Medical Science of China Three Gorges University(Yichang Central People's Hospital),Yichang,Hubei 443003,China;Department of Vascular Surgery,Chinese People's Liberation Army General Hospital,Beijing 100141,China;Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]三峡大学第一临床医学院(湖北省宜昌市中心人民医院)血管外科,湖北宜昌443003 [2]中国人民解放军总医院血管外科,北京100141 [3]复旦大学附属中山医院血管外科,上海200032

出　　处：《中国普通外科杂志》2024年第12期2051-2057,共7页China Journal of General Surgery

基　　金：湖北省科技厅中央引导地方科技发展专项基金资助项目(2022BGE237)。

摘　　要：腹主动脉瘤(AAA)是一类具有较高致死率的扩张性主动脉疾病,动脉瘤腔内修复术(EVAR)是治疗该病的有效手段,但内漏可在术中或数年后发生,因此必须进行终身监测。Ⅱ型内漏(T2EL)是EVAR的主要并发症,主要源于肠系膜下动脉(IMA)、腰动脉(LA)等侧支血管的反流血持续灌注动脉瘤囊。T2EL的发生与患者的解剖因素(如侧支血管的直径、数量和通畅情况)、手术相关因素(如支架移植物与动脉壁的贴合程度)以及高血压等密切相关。持续的T2EL可能导致动脉瘤囊增大、破裂风险增加,影响患者的预后。近年来,预防性栓塞IMA和LA在降低T2EL发生率、瘤囊增大率和再干预率等方面展现出一定优势,对改善患者的治疗效果和生活质量有积极作用。笔者检索了2002年1月—2024年7月间发表的有关EVAR术后内漏的流行病学、EVAR术中栓塞IMA和LA预防T2EL的相关文献,对当前的研究进行了总结,探讨T2EL高风险患者预防性栓塞IMA、LA的临床价值。Abdominal aortic aneurysm(AAA)is a type of aneurysmal aortic disease with a high mortality rate.Endovascular aneurysm repair(EVAR)is an effective treatment for this condition,but endoleaks can occur intraoperatively or years after the procedure,necessitating lifelong monitoring.Type II endoleak(T2EL)is a major complication of EVAR,primarily caused by persistent retrograde perfusion of the aneurysm sac from collateral vessels such as the inferior mesenteric artery(IMA)and lumbar arteries(LA).The occurrence of T2EL is closely related to patient anatomical factors(e.g.,the diameter,number,and patency of collateral vessels),surgical factors(e.g.,the degree of stent graft adherence to the arterial wall),and systemic factors such as hypertension.Persistent T2EL may lead to aneurysm sac enlargement and increased risk of rupture,thereby adversely affecting patient prognosis.In recent years,prophylactic embolization of the IMA and LA has shown certain advantages in reducing the incidence of T2EL,aneurysm sac enlargement,and reintervention rates,contributing positively to improving treatment outcomes and quality of life of the patients.Here,the authors reviewed literature published between January 2002 and July 2024 on the epidemiology of endoleaks following EVAR and the use of IMA and LA embolization during EVAR to prevent T2EL.The current research was summarized to discuss the clinical value of prophylactic IMA and LA embolization in patients at high risk of T2EL.

关 键 词：主动脉瘤 腹 血管内操作 内漏 栓塞 治疗性 

分 类 号：R654.3[医药卫生—外科学]