Transealing: A Novel and Simple Technique for Embolization of Type 2 Endo leaks Through Direct Sac Access From the Distal Stent-graft Landing Zone
Transealing: A Novel and Simple Technique for Embolization of Type 2 Endo leaks Through Direct Sac Access From the Distal Stent-graft Landing Zone
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DOI：
10.1016/j.ejvs.2014.01.013
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发表时间：
2014-04-01
影响因子：
5.7
通讯作者：
Silingardi, R.
中科院分区：
文献类型：
--
作者：
Coppi, G.;Saitta, G.;Silingardi, R.
目的：2型内漏（T2EL）是腹主动脉瘤腔内修复的致命弱点。本文描述了治疗t2el的另一种技术——横切术的经验。方法：回顾性分析1组患者行穿刺治疗的结果。用9-Fr护套获得股骨通路。在支架移植物内放置超硬导丝和硬亲水导丝，并插入Piton GC导管。取出坚硬的亲水导线，使导管恢复其曲率，导管尖端紧贴髂壁，在支架移植物的边缘。然后将亲水性金属丝从支架移植物和动脉壁之间插入囊内。在囊内插入5/6-Fr引入器，并进行血管造影以评估泄漏情况。使用线圈、氰基丙烯酸酯或纤维蛋白胶。取出导管后，髂肢体肿胀。结果：2009年2月至2013年4月共治疗17例患者。在16/17次尝试中有可能进入动脉瘤。1例丙烯胶治疗后出现结肠缺血。术中1例继发性1b型内漏经髂外展治疗。平均随访21.5个月。14例患者完成了3个月的随访，内漏率为53%。1年后，利率为45%。在研究期间，有一例手术转化，一例动脉瘤生长和一例再栓塞手术。剩余的泄漏保持稳定。结论：本研究表明，在选定的患者中，转肠术是可行的，是一种有效的替代方法。该技术的优点主要是侵入性低、成本低、使用方便。(C) 2014欧洲血管外科学会。Elsevier Ltd.出版。版权所有。
Objective: Type 2 endoleak (T2EL) is the Achilles' heel of endovascular abdominal aortic aneurysm repair. Experience with transealing, an alternative technique for the treatment of T2ELs, is described.Methods: The outcome of a group of patients treated with transealing has been reviewed. Femoral access was obtained with a 9-Fr sheath. A super-stiff guide wire and a stiff hydrophilic wire were placed inside the stent-graft and a Piton GC catheter inserted. The stiff hydrophilic wire was retrieved to allow the catheter to regain its curvature and the catheter tip was placed against the iliac wall, at the edge of the stent-graft. The hydrophilic wire was then forced between the stent-graft and arterial wall into the sac. A 5/6-Fr introducer was inserted inside the sac and angiography was performed to evaluate the leak. Coils, cyanoacrylate, or fibrin glue were deployed. After removal of the catheters, the iliac limb was ballooned.Results: Seventeen patients were treated between February 2009 and April 2013. It was possible to access the aneurysm in 16/17 attempts. One patient treated with acrylic glue suffered from colon ischemia. One intraoperative secondary type 1b endoleak was treated with an iliac extension. Mean follow-up was 21.5 months. Three months of follow-up were completed in 14 patients with a 53% freedom from endoleak rate. At 1 year, the rate was 45%. During the study period, there was one surgical conversion, one aneurysm growth, and one re-embolization procedure. The remaining leaks remained stable.Conclusions: This study shows that transealing is feasible and represents a valid alternative in selected patients. The advantages of this technique are mainly its low invasiveness, reduced costs, and ease of use. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.