腹主动脉瘤患者用排他性支架系统修复血管内动脉瘤后II型内漏。

Keigo Matsushiro, Tomoyuki Gentsu, Masato Yamaguchi, Koji Sasaki, Eisuke Ueshima, Takuya Okada, Ryota Kawasaki, Koji Sugimoto, Takamichi Murakami
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摘要

目的:本研究旨在评估使用exender装置进行腹主动脉瘤腔内修复的患者II型腔内泄漏的发生率及其结果。材料与方法:回顾性分析2008年至2017年间167例腹主动脉瘤腔内修复患者(96例腹主动脉瘤未闭,71例肠系膜下动脉闭塞)。观察II型腔内漏发生率及腔内动脉瘤修复后bbb50mm的增大情况。根据术前患者及解剖特点,对动脉瘤修复及扩大后6个月晚期II型内漏的预测因素进行评估。结果:肠系膜下动脉未闭的晚期II型内漏发生率较高,为42.7% (41/96;95%可信区间,33.3-52.7),而22.5% (16/71;95%可信区间为13.5 ~ 34.0),与肠系膜下动脉闭塞组比较(p = 0.01)。肠系膜下动脉通畅组1、3、5年动脉瘤囊扩张的自由度分别为100%、85.0%、68.1%,肠系膜下动脉闭塞组分别为98.9%、86.7%、73.9% (p = 0.22)。晚期II型内漏患者1年、3年、5年动脉瘤囊膨出率分别为100%、76.9%、43.5%、99.1%、90.6%、87.8% (p < 0.01)。肠系膜下动脉未闭(优势比3.43;95%可信区间,1.43-8.21),腰椎动脉未闭数量增加(优势比,2.14;95%可信区间(1.48 ~ 3.08)为晚期II型内漏的危险因素。结论:肠系膜下动脉未闭在使用exender进行血管内动脉瘤修复后,有发生晚期II型内漏的风险,但不会导致动脉瘤扩大。晚期II型内漏伴动脉瘤增大。肠系膜下动脉未闭和腰椎动脉未闭是晚期II型内漏的危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Type II Endoleak after Endovascular Aneurysm Repair Using the EXCLUDER Stent Graft System in Patients with Abdominal Aortic Aneurysm.

Purpose: This study aimed to evaluate type II endoleak incidence and its outcome in patients who underwent endovascular aneurysm repair using the EXCLUDER device for abdominal aortic aneurysm. Material and Methods: One hundred sixty-seven patients who underwent endovascular aneurysm repair for abdominal aortic aneurysm (96 with patent and 71 with occluded inferior mesenteric artery) between 2008 and 2017 were retrospectively evaluated. Type II endoleak incidence and aneurysm enlargement of >5 mm after endovascular aneurysm repair were evaluated. The predictive factors for late type II endoleak identified >6 months after endovascular aneurysm repair and aneurysm enlargement were assessed based on the preoperative patient and anatomical characteristics. Results: Late type II endoleak incidence was higher in the patent inferior mesenteric artery at 42.7% (41/96; 95% confidence interval, 33.3-52.7), compared with 22.5% (16/71; 95% confidence interval, 13.5-34.0) in the occluded inferior mesenteric artery group (p = 0.01). Freedom from aneurysm sac enlargement at 1, 3, and 5 years was 100%, 85.0%, and 68.1% in the patent inferior mesenteric artery and 98.9%, 86.7%, and 73.9% in the occluded inferior mesenteric artery group, respectively (p = 0.22). Freedom from aneurysm sac enlargement at 1, 3, 5 years was 100%, 76.9%, 43.5%, and 99.1%, 90.6% and 87.8% in the patients with and without late type II endoleak (p < 0.01). Patent inferior mesenteric artery (odds ratio, 3.43; 95% confidence interval, 1.43-8.21) and an increasing number of patent lumbar arteries (odds ratio, 2.14; 95% confidence interval, 1.48-3.08) were risk factors for late type II endoleak. Conclusions: Patent inferior mesenteric artery was a risk for late type II endoleak without contributing to aneurysm enlargement after endovascular aneurysm repair using the EXCLUDER. Late type II endoleak was associated with aneurysm enlargement. Patent inferior mesenteric artery and an increasing number of patent lumbar arteries were risk factors for late type II endoleak.

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