腹主动脉瘤腔内治疗并发症内漏的诊治

目的 探讨血管内技术治疗腹主动脉瘤时特有并发症内漏的诊断与处理方法。方法 对已施行腔内治疗37例腹主动脉瘤患者进行回顾性分析，讨论部分患者并发内漏的原因、诊断、处理、结果及预后。结果 37例支架型血管放置完成后，13例发现存在不同程度的内漏，其中I型6例，Ⅱ型3例，Ⅲ型2例，Ⅳ型1例，不明原因1例，1期经相关技术处理后I型、Ⅲ型内漏完全消失。手术结束时原发性内漏发生率13．5％（5／37）。随诊发现原发性内漏3例自愈，2例转化为持续性内漏；另发现2例继发性内漏发生率13．5％（5／37）。随诊发现原发性内漏3例自愈，2例转化为持续性内漏；另发现2例继发发现人漏。本组患者晚期内漏发生率10．8％（4／37）。结论 引起漏血的原因可能与瘤颈形态、长度、成角、钙化、移植物选择、分支血管血液倒流等因素有关。强调术中发现并一期处理，术后应密切随访。增强CT、血管超声和MRA检查是术检后检测内漏的主要手段。对漏血量及瘤体有增大趋势的内漏应积极处理。

Diagnosis and management of endoleak after endovascular repair of abdominal aortic aneurysm

OBJECTIVE: To determine the diagnosis and management of endoleak after endovascular repair of abdominal aortic aneurysm (AAA). METHODS: We analysed retrospectively the data of 37 cases of infrarenal AAA treated by endovascular repair and investigated the reasons, managements, results and prognosis of endoleaks. RESULTS: Of 13 patients with endoleak at stent-graft deployment, 6 developed type I endoleak, 3 type II endoleak, 2 type III endoleak, 1 type IV endoleak, and 1 unknown reason. Type I and III endoleaks disappeared after management with additional techniques. The primary endoleak rate was 13.5%(5/37). Three sealed endoleak, 2 persistent endoleaks and 2 secondary endoleaks were found during follow up. The late endoleak rate was 10.8% (4/37). CONCLUSIONS: Endoleak is a chief complication after endovascular repair of infrarenal AAA. The influencing factors for endoleak include neck morphology, distance, angulation, calcification, stent-graft selection and side branching arteries. Additional procedure and follow up are very important. Techniques to find endoleak include CTA, Duplex and MRA after operation. Endoleak with enlarged aneurysm should be treated actively.