Embo-EVAR: A Technique to Prevent Type II Endoleak? A Single-Center Experience
Embo-EVAR: A Technique to Prevent Type II Endoleak? A Single-Center Experience
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DOI：
10.1016/j.avsg.2017.01.028
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发表时间：
2017-10-01
影响因子：
1.5
通讯作者：
Peinetti, Flavio
中科院分区：
文献类型：
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作者：
Natrella, Massimiliano;Rapellino, Alessandro;Peinetti, Flavio
背景资料：在腹主动脉瘤腔内修复术（EVAR）期间使用弹簧圈和纤维蛋白胶进行术中动脉瘤囊栓塞（EVAR）是一种预防II型内漏（EII）的技术。我们的目的是评估这种有前途的approach.Materials和方法的可行性，安全性和临床结局：回顾性临床病例分析的72例患者进行腹主动脉瘤腔内修复术在2011年至2014年期间。在6个月和12个月随访时，通过造影剂计算机断层扫描和超声造影（CEUS）成像对两组进行比较：连续36例患者（A组）接受传统腹主动脉瘤腔内修复术治疗，36例患者（B组）接受腹主动脉瘤腔内修复术治疗。释放弹簧圈，尽可能更好地填充动脉瘤囊;通过注射纤维蛋白胶完成栓塞。使用的器械和材料，不同的全身和囊压，存在任何内漏，并发症registered.Results：在我们的经验，我们有100%的技术成功，没有手术转换。在覆膜支架展开后，对B组患者进行了Embo-EVAR，所有患者的Δ压力比（从Δ囊压/Δ压差获得）> 0.16。无早期或晚期并发症发生，死亡率为零。在6个月和12个月时，通过计算机断层扫描-血管造影和CEUS进行随访。我们观察到A组有9例II型内漏和1例Ia型内漏，B组有2例II型内漏和1例Ib型内漏。A组平均辐射暴露时间为30.3 min，B组为43.3 min。腹主动脉瘤腔内修复术的平均成本为9，000美元（原文如此）。囊栓塞的平均费用为1，500美元（原文如此）。结论：尽管有必要进行随机研究，但腹主动脉瘤腔内修复术可能是预防II型内漏和进一步并发症的有效方法。为避免再次干预，可以接受适度的费用和增加剂量，根据我们的经验，可以常规进行，效果良好。
Background: Intraprocedural aneurysm sac embolization (embo-EVAR) during endovascular abdominal aneurysm repair (EVAR) using coils and fibrin glue is a technique for preventing type II endoleak (EII). Our aim is to evaluate feasibility, safety and clinical outcome of this promising approach.Materials and Methods: A retrospective clinical case analysis of 72 patients who underwent EVAR during the period 2011-2014. Two groups were compared at 6 and 12 months follow-up with contrast media computed tomography scan and contrast-enhanced ultrasound (CEUS) imaging: consecutively, 36 patients (group A) treated with classic EVAR and 36 patients (group B) treated with embo-EVAR. Coils were released filling better as possible the aneurysm sac; the embolization was completed by injecting fibrin glue. Device and materials used, differential systemic and sac pressures, presence of any endoleak, and complication were registered.Results: In our experience, we had 100% technical success without surgical conversion. Embo-EVAR was performed, after endograft deployment, in group B patients, all with ratio of Delta-pressures (obtained from Delta-sac pressure/Delta-differential pressure) > 0.16. No early or late complications occurred and mortality was nil. Follow-up was performed with computed tomography-angiography and CEUS at 6 and 12 months. We observed 9 type II and 1 type Ia endoleak in group A and 2 type II and 1 type Ib endoleaks in group B. Mean radiation exposure time was 30.3 min in group A and 43.3 min in group B. EVAR procedure average cost was 9,000 (sic). The average cost of sac embolization was 1,500 (sic).Conclusions: Although a randomized study is necessary, embo-EVAR may be a valid approach to prevent type II endoleaks and further complications. Mild costs and exposure-dose increase could be accepted to avoid reinterventions, and in our experience, it could be routinely performed with excellent results.