Pre-emptive nonselective perigraft aortic sac embolization with coils to prevent type II endoleak after endovascular aneurysm repair
Pre-emptive nonselective perigraft aortic sac embolization with coils to prevent type II endoleak after endovascular aneurysm repair
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DOI：
10.1016/j.jvs.2018.10.054
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发表时间：
2019-06-01
影响因子：
4.3
通讯作者：
Dryjski, Maciej L.
中科院分区：
文献类型：
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作者：
Dosluoglu, Hasan H.;Rivero, Mariel;Dryjski, Maciej L.
目的：肠系膜下动脉(IMA)、腰动脉(LAS)和移植物周囊的预防性选择性栓塞术预防II型内漏(T2EL)尚未得到广泛应用。我们对T2EL高危患者(4个或更多LAS未闭，IMA和GT；未闭3 mm，主动脉血流管腔<30 mm)行非选择性血管周动脉囊栓塞术(PNPASEC)。这项研究的目的是观察PNPASEC是否减少了需要再次介入的T2 ELs。方法：从2007年9月1日至2015年10月31日，从前瞻性维护的数据库中对所有266例接受选择性血管内动脉瘤修补术的患者进行回顾性评估。患者(N=212；211名男性)在手术前和手术后进行了增强CT扫描。我们的PNPASEC技术包括在对侧门插管后在囊中留一根钢丝，并在分叉移植物部署后将大(0.035英寸)线圈插入囊中。比较接受PNPASEC的患者(I组)、符合PNPASEC的患者(II组)和不符合PNPASEC的患者(III组)的T2 EL和再干预率。在PNPASEC候选人中，16人(7.5%)接受了PNPASEC(组I)，31人(14.6%)没有接受PNPASEC(组II)。在合并症、动脉瘤大小、解剖特征和颈部特征方面，两组之间没有显著差异。I组(4.5+/-0.8)和II组(4.5+/-0.9)的平均LAS通畅数相似，显著高于III组(1.9+/-1.3；P<；.001)，43.6%的III组患者有IMA通畅。平均随访时间为44+/-25个月。6个月时T2EL发生率II组为48.4%，III组为3.0%，I组为6.3%(P<0.01)。囊腔直径增大，II组为38.7%，III组为6.1%，I组为6.3%(P=.001)，囊腔完全缩小率为23.3%，III组为23.8%，I组为50.0%(P=0.09)。T2 EL相关干预在II组为29.0%，在III组为1.2%，在I组为6.3%(P<；.001)。末次随访时，II组25.8%、III组2.4%、I组无一例发生内漏(P<；.001)。结论：对于T2EL高危患者(20%接受血管内瘤内修补术)，非选择性球囊栓塞术能有效地预防T2EL的发生，并与囊腔大小和再干预率有关。
Objective: Pre-emptive selective embolization of inferior mesenteric artery (IMA), lumbar arteries (LAs), and perigraft sac for prevention of type II endoleak (T2EL) has not been widely adopted. We perform pre-emptive nonselective perigraft aortic sac embolization with coils (PNPASEC) in patients at high risk for development of T2EL (four or more patent LAs, patent IMA >= 3 mm, and >= 30-mm aortic flow lumen). The goal of this study was to see whether PNPASEC decreases T2ELs requiring reinterventions.Methods: All 266 patients undergoing elective endovascular aneurysm repair between September 1, 2007, and October 31, 2015, were retrospectively evaluated from a prospectively maintained database. Patients (N = 212; 211 men) with preoperative and postoperative contrast-enhanced computed tomography scans were included. Our PNPASEC technique involves leaving a wire in the sac after cannulation of the contralateral gate and inserting large (0.035-inch) coils into the sac after bifurcated graft deployment. T2EL and reintervention rates were compared between patients who underwent PNPASEC (group I) and those who met the criteria but did not have PNPASEC (group II) and those who did not meet the criteria (Group III).Results: Forty-seven (22.2%) patients were PNPASEC candidates and 165 (77.8%) patients (group III) were not. Among PNPASEC candidates, 16 (7.5%) underwent PNPASEC (group I) and 31 (14.6%) did not (group II). There were no significant differences between groups in terms of comorbidities, aneurysm size, and anatomic and neck characteristics. Mean number of patent LAs was similar between group I (4.5 +/- 0.8) and group II (4.5 +/- 0.9), which was significantly greater than in group III (1.9 +/- 1.3; P < .001); 43.6% of group III patients had patent IMA. Mean follow-up was 44 +/- 25 months. T2EL at 6 months was observed in 48.4% in group II, 3.0% in group III, and 6.3% in group I (P < .001). Sac diameter increase was seen in 38.7% in group II vs 6.1% in group III and 6.3% in group I (P < .001), with complete sac shrinkage in 23.3% in group II vs 23.8% in group III and 50.0% in group I (P = .09). T2EL-related interventions were performed in 29.0% in group II vs 1.2% in group III and 6.3% in group I (P < .001). Any endoleak at last follow-up was seen in 25.8% in group II vs 2.4% in group III and none in group I (P < .001).Conclusions: Nonselective perigraft sac coil embolization in patients at high risk for T2EL (20% of patients undergoing endovascular aneurysm repair) is effective in preventing development of T2EL and is associated with decrease in sac size and reintervention rates.