Type II endoleak after endovascular aneurysm repair
Type II endoleak after endovascular aneurysm repair
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DOI：
10.1002/bjs.9181
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发表时间：
2013-09-01
影响因子：
9.6
通讯作者：
Sayers, R. D.
中科院分区：
文献类型：
--
作者：
Sidloff, D. A.;Stather, P. W.;Sayers, R. D.
背景资料：目的是评估破裂的风险，并确定腹主动脉瘤腔内修复术（EVAR）后II型内漏的干预治疗的受益。方法：根据PRISMA指南进行本系统综述。结果数据包括发生率、自发性消退、囊扩张、干预、临床成功和并发症，包括转为开放性修复和rupture.Results：纳入了32项非随机回顾性研究，共21744例接受腹主动脉瘤腔内修复术的患者。有1515例II型内漏和393例干预。腹主动脉瘤腔内修复术后，102%的患者出现II型内漏; 354%自发消退。14例孤立II型内漏患者（09%）有腹主动脉瘤破裂;其中6例没有已知的动脉瘤囊扩张。在393例II型内漏干预中，285%不成功。经腰椎栓塞的临床成功率高于经动脉栓塞（分别为81%和625%; P=0024），报告的复发性内漏较少（19%和358%; P=0036）。经动脉栓塞术的并发症发生率也较高（92% vs 0; P=0043）。结论：腹主动脉瘤腔内修复术后继发于孤立II型内漏的主动脉瘤破裂很少见（不到1%），但超过三分之一发生在没有囊扩张的情况下。经腰动脉栓塞的成功率更高，并发症风险更低。
Background: The aim was to assess the risk of rupture, and determine the benefits of intervention for the treatment of type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR).Methods: This systematic review was done according to PRISMA guidelines. Outcome data included incidence, spontaneous resolution, sac expansion, interventions, clinical success, and complications including conversion to open repair, and rupture.Results: Thirty-two non-randomized retrospective studies were included, totalling 21744 patients who underwent EVAR. There were 1515 type II endoleaks and 393 interventions. Type II endoleak was seen in 102 per cent of patients after EVAR; 354 per cent resolved spontaneously. Fourteen patients (09 per cent) with isolated type II endoleak had ruptured abdominal aortic aneurysm; six of these did not have known aneurysm sac expansion. Of 393 interventions for type II endoleak, 285 per cent were unsuccessful. Translumbar embolization had a higher clinical success rate than transarterial embolization (81 versus 625 per cent respectively; P=0024) and fewer recurrent endoleaks were reported (19 versus 358 per cent; P=0036). Transarterial embolization also had a higher rate of complications (92 per cent versus none; P=0043).Conclusion: Aortic aneurysm rupture after EVAR secondary to an isolated type II endoleak is rare (less than 1 per cent), but over a third occur in the absence of sac expansion. Translumbar embolization had a higher success rate with a lower risk of complications.