Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Luca Mezzetto, Lorenzo Grosso, Mario D'Oria, Jacopo Weindelmayer, Simone Giacopuzzi, Giovanni De Manzoni, Gian Franco Veraldi
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引用次数: 0

Abstract

Introduction: The occurrence of type II endoleak (T2EL) presents a significant challenge in standard endovascular aneurysm repair (EVAR), with ongoing debate in the literature regarding its optimal management. Although spontaneous resolution has been observed in many cases, intervention is often required to prevent progressive sac enlargement and rupture. Various approaches have been described, including translumbar, transarterial, and transcaval embolization, as well as direct sac puncture. The aim of this study is to evaluate the role of videolaparoscopic-guided saccography and direct sac embolization (ViSE) in patients with sac enlargement following EVAR.

Methods: A prospectively maintained registry of patients undergoing standard EVAR between 2016 and 2022 at our institution was retrospectively reviewed. Exclusion criteria included concomitant computed tomography (CT)-diagnosed type I endoleak or type III endoleak (T1EL or T3EL), less than 6 months of follow-up, or no available imaging study for review. A nidus posterior to the main body of endograft and a hostile abdomen (severe obesity body mass index [BMI] >35 kg/m2, previous open surgery, or history of peritonitis) were considered contraindications to ViSE.

Results: A total of 259 standard EVAR procedures were performed during the study period, with 63 patients (24.3%) identified as having T2EL, 26 underwent endovascular treatment for significant sac growth during follow-up; 14 of these patients received ViSE (5.4%) and were included in the study. The median procedure time and median fluoroscopic time were 140 (interquartile range [IQR]=105-150) and 40.5 (IQR=31-45) minutes, respectively. Technical success was achieved in 12 of 14 patients (87%). In 7 patients (50%), the inferior mesenteric artery (IMA) was ligated. An occult T1EL or T3EL endoleak was revealed in 5 patients (35%), requiring an immediate or staged adjunct procedure. After a median follow-up of 32.4 months (IQR=25.3-51.7), 2 patients presented sac growth and required surgical conversion. None of the patients died due to aortic-related causes.

Conclusion: Videolaparoscopic-guided saccography and direct sac embolization may be considered a valid alternative in patients with T2EL and sac growth. In our early experience, it has proven to be safe and effective in treating the nidus and IMA, and identifying hidden T1EL or T3EL.

Clinical impact: Videolaparoscopic-guided saccography and direct sac embolization (ViSE) represent a valuable option for managing type II endoleak (T2EL) with sac enlargement after EVAR. This approach allows precise treatment of the nidus and the inferior mesenteric artery while also identifying undetected type I and III endoleaks that may require further intervention. By integrating ViSE into clinical practice, physicians can improve diagnostic accuracy and expand treatment strategies for complex endoleak cases. The technique enhances endovascular options, potentially reducing the need for open conversion and improving long-term outcomes in patients with persistent sac growth.

内镜引导下的糖膜造影和标准EVAR后的直接囊栓塞。
II型内漏(T2EL)的发生对标准血管内动脉瘤修复(EVAR)提出了重大挑战,关于其最佳处理方法的文献一直存在争议。虽然在许多病例中观察到自发消退,但通常需要干预以防止囊扩大和破裂。各种方法已被描述,包括经腰椎、经动脉、经腹腔栓塞,以及直接囊穿刺。本研究的目的是评估腹腔镜引导下的糖膜造影和直接囊栓塞(ViSE)在EVAR后囊增大患者中的作用。方法:回顾性分析2016年至2022年在我院接受标准EVAR的患者的前瞻性维护登记。排除标准包括伴有计算机断层扫描(CT)诊断的I型或III型内漏(T1EL或T3EL),随访时间少于6个月,或没有可用的影像学研究。内移植物主体后方的病灶和不良腹部(严重肥胖体重指数[BMI] bb0 - 35 kg/m2,既往开放手术或腹膜炎史)被认为是ViSE的禁忌症。结果:在研究期间共进行了259次标准EVAR手术,其中63例(24.3%)确诊为T2EL, 26例在随访期间因明显的囊生长而接受了血管内治疗;其中14例患者接受了ViSE治疗(5.4%),并纳入研究。中位手术时间和中位透视时间分别为140分钟(四分位间距[IQR]=105-150)和40.5分钟(IQR=31-45)。14例患者中有12例(87%)技术成功。结扎肠系膜下动脉7例(50%)。5例(35%)患者发现隐匿性T1EL或T3EL内漏,需要立即或分期进行辅助手术。中位随访32.4个月(IQR=25.3-51.7), 2例患者出现囊生长,需要手术转化。没有患者死于与主动脉相关的原因。结论:腹腔镜引导下的糖尿造影和直接囊内栓塞可能被认为是T2EL和囊内生长患者的有效选择。在我们早期的经验中,它已被证明是安全有效的治疗病灶和IMA,并识别隐藏的T1EL或T3EL。临床影响:腹腔镜引导下的糖膜造影和直接囊栓塞(ViSE)是治疗EVAR后伴有囊增大的II型内漏(T2EL)的一种有价值的选择。这种方法可以精确治疗病灶和肠系膜下动脉,同时也可以识别未被发现的可能需要进一步干预的I型和III型内漏。通过将ViSE整合到临床实践中,医生可以提高诊断的准确性,并扩展复杂的内漏病例的治疗策略。该技术增加了血管内选择,潜在地减少了开放转换的需要,并改善了持续囊生长患者的长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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