Type II endoleak prevention with coil embolization during endovascular aneurysm repair in high-risk patients
Type II endoleak prevention with coil embolization during endovascular aneurysm repair in high-risk patients
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DOI：
10.1016/j.jvs.2015.02.030
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发表时间：
2015-07-01
影响因子：
4.3
通讯作者：
Angel, Claude
中科院分区：
文献类型：
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作者：
Fabre, Dominique;Fadel, Elie;Angel, Claude
目的：本研究评价了II型内漏高风险患者在动脉瘤腔内修复术（EVAR）联合弹簧圈栓塞后肾下腹主动脉瘤（AAA）的内漏水平和尺寸减小情况。在2009年至2013年期间，187例患者中的83例（44.3%）由于风险因素，接受腹主动脉瘤腔内修复术治疗AAA的患者在覆膜支架完全释放后立即接受了动脉瘤囊弹簧圈栓塞对于II型内漏，包括无周向血栓、两对或多对通畅的腰动脉或通畅的肠系膜下动脉。使用4F导管实现弹簧圈栓塞，并将微导管置于覆膜支架和动脉瘤壁之间。计算机断层扫描和彩色多普勒超声成像进行了1，6，12和24个月后，寻找内漏和评估动脉瘤囊diameter.Results：平均随访时间为24 - 6 - 11个月（范围，6-53个月）。平均使用12个弹簧圈（范围，4-23）。所有患者均获得技术成功，无手术相关并发症。随访计算机断层扫描显示1例患者存在II型内漏。6个月（P = .001）、12个月（P =.001）和24个月（P =.001）后，动脉瘤囊直径显著减小。一名患者的股总动脉闭塞与手术无关，另一名患者的远端I型endoleak.Conclusions：腹主动脉瘤腔内修复术中动脉瘤囊弹簧圈栓塞术对II型内漏风险患者在技术上是可行的，安全的，有效地防止II型内漏。该过程导致AAA快速收缩。因此，弹簧圈栓塞可常规用于改善II型内漏风险患者的腹主动脉瘤腔内修复术结局。
Objective: This study evaluated endoleak level and size decrease of infrarenal abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) with coil embolization in patients at high risk for type II endoleak.Methods: Between 2009 and 2013, 83 of 187 patients (44.3%) who underwent EVAR for AAA also underwent coil embolization of the aneurysm sac immediately after complete stent graft release because of risk factors for type II endoleak, including absence of a circumferential thrombus, two or more pairs of patent lumbar arteries, or a patent inferior mesenteric artery. Coil embolization was achieved using a 4F catheter with a microcatheter placed between the stent graft and the aneurysm wall. Computed tomography and color duplex ultrasound imaging were performed 1, 6, 12, and 24 months later to look for an endoleak and assess aneurysm sac diameter.Results: Mean follow-up was 24 6 11 months (range, 6-53 months). A mean of 12 coils (range, 4-23) was used. Technical success was achieved in all patients, with no procedurally related complications. Follow-up computed tomography showed type II endoleak in one patient. Aneurysm sac diameter was significantly decreased after 6 months (P = .001), 12 months (P = .001), and 24 months (P = .001). Surgery was required in one patient for common femoral artery occlusion unrelated to the procedure and in another patient for distal type I endoleak.Conclusions: Aneurysm sac coil embolization during EVAR for patients at risk for type II endoleak is technically feasible, safe, and effective in preventing type II endoleak. This procedure leads to rapid AAA shrinkage. Thus, coil embolization could be used routinely to improve EVAR outcomes for patients at risk for type II endoleak.