腹主动脉瘤患者腔内修复术后Ⅱ型内漏的处理分析

目的 探讨腹主动脉瘤腔内修复术(EVAR)后Ⅱ型内漏的处理.方法 选择解放军总医院血管外科2009年1月至2011年7月10例确诊肾下腹主动脉瘤EVAR术后Ⅱ型内漏的病例,根据内漏罪犯血管不同,选择腔内途径超选择栓塞结合CT引导下经皮穿刺瘤腔内注射纤维蛋白胶进行治疗,并随访观察.结果 10例患者中9例接受治疗,8例接受随访,平均随访时间(2.4±1.6)个月(1～6个月),二次干预年限平均(62±39)个月(11～132个月);罪犯血管肠系膜下动脉来源3例,2例经肠系膜上动脉入路弹簧圈栓塞治疗,1例未治;髂内动脉来源1例,髂内动脉-腰动脉来源3例,均经弹簧圈栓塞;腰动脉来源3例,2例经皮穿刺球囊内注射治疗,1例弹簧圈栓塞.随访期因心脑血管意外死亡2例;初期技术成功率44％,再干预率33％,总体治疗有效率89％.结论 腹主动脉瘤腔内修复术后Ⅱ型内漏整体自然预后较温和,对造成瘤体持续显著增长者可积极干预,腔内栓塞结合瘤腔内注射术是一种近期效果尚可.

Treatment of type II endoleak after abdominal aortic aneurysm endovascular repair

Objective To explore the treatment of type Ⅱ endoleak (TEE) after the endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).Methods From January 2009 to July 2011,10 patients with type Ⅱ endoleak after AAA EVAR were recruited.Different treatment methods were employed for the criminal arteries,including transcatheter embolization with coils,percutaneous sac puncture,intrasac injection of fibrin glue and outcome follow-up.Results Among them,9 patients underwent treatment and 8 received a mean follow-up of (2.4 ± 1.6) months.The mean secondary time was (62 ±39) months.The criminal arteries were inferior mesenteric artery (n =3),internal iliac artery (IA)( n =1 ),IA with lumbar artery ( n =3 ) and lumbar artery ( n =3 ).Two patients died from cardiovascular and cerebrovascular events during the follow-up.The primary technical success was 44％,retreat rate 33％ and clinical success rate 89％.Conclusion Type Ⅱ endoleak has a relatively benign course.In the absence of sac expansion,it can be followed for a long period of time without the needs for intervention.Treatment is necessary when it persists beyond 12 months or when there is a significant increase in aneurysm sac diameter.