Occurrence and outcomes of type 3 endoleaks in endovascular aortic repair within the Vascular Quality Initiative database
Occurrence and outcomes of type 3 endoleaks in endovascular aortic repair within the Vascular Quality Initiative database
复制标题
DOI：
10.1136/bmjsit-2020-000054
复制
发表时间：
2020-03-23
期刊：
影响因子：
--
通讯作者：
Spangler, Emily
中科院分区：
文献类型：
--
作者：
Blakeslee-Carter, Juliet;Beck, Adam;Spangler, Emily
目的3型内漏（T3 EL）代表缺乏动脉瘤对全身压力的保护。既往研究发现，标准肾下动脉瘤腔内修复术（EVAR）后T3 EL的发生率接近2%;然而，既往使用新一代器械的研究无法确定T3 EL与临床结局之间的相关性。在此，我们在血管外科学会血管质量倡议（VQI）中检查T3 EL，以确定这些内漏的发生率、再介入率和模式以及临床后果。设计和设置在回顾性队列研究中分析了2003年1月至2018年9月在VQI中接受肾下腹主动脉瘤腔内修复术的参与者。参与者在腹主动脉瘤腔内修复术登记研究的42246例登记中，41604具有完整的手术信息，并被纳入分析。其中36082例进行了长期随访，26422例进行了随访（根据VQI报告标准为9-21个月），记录完整的内漏数据。干预本研究中纳入的所有患者均接受了肾下腹主动脉瘤腔内修复术。结果在VQI数据库中，首次住院期间肾下腹主动脉瘤腔内修复术的T3 EL发生率为0. 37%。（n=157/41 604），其中85%是由于移植物中部分离，15%是由于织物断裂。在157例首次住院T3 EL中，4.5%（n=7）在住院期间接受了手术再干预，占所有首次住院再干预的1%。在21个月随访期间，T3 EL事件发生率为0.7%（n=205/26422），占随访期间观察到的所有内漏的5%。30例患者（发生率0.1%）在随访时因T3 EL事件进行了再次干预，占内漏再次干预的9%，占所有再次干预的3.3%。Kaplan-Meier分析显示，随访期间发现的T3 EL事件与5年生存率显著降低相关（分别为74%和80%; p=0.041）。结论：置入和随访时的T3 EL率仍然较低;然而，长期随访中报告的大多数事件为内漏，这些事件与腹主动脉瘤腔内修复术的生存率降低相关。
Objectives Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressure. Previous studies have found a similar to 2% incidence of T3EL after standard infrarenal endovascular aneurysm repair (EVAR); however, no prior studies with new-generation devices have been able to determine an association between T3EL and clinical outcomes. Here we examine T3EL within the Society for Vascular Surgery Vascular Quality Initiative (VQI) to define rates of occurrence, rates and modes of reintervention, and clinical consequences of these endoleaks.Design and setting Participants receiving infrarenal EVAR in the VQI from January 2003 to September 2018 were analyzed in a retrospective cohort study.Participants Of 42246 entries in the EVAR procedural registry, 41604 had complete procedural information and were included in analysis. Of these, 36082 had long-term follow-up, and 26422 had follow-up (9-21 months per VQI reporting standards) with complete endoleak data recorded.Interventions All patients included in this study underwent an infrarenal EVAR.Results Within the VQI database, the rate of T3EL in infrarenal EVAR during index hospitalization was 0.37% (n=157/41 604), of which 85% were due to midgraft separation and 15% were due to fabric disruptions. Out of the 157 index hospitalization T3ELs, 4.5% (n=7) received procedural reintervention during that hospitalization, which accounted for 1% of all index hospitalization reinterventions. During the 21-month follow-up, the rate of incident T3EL was 0.7% (n=205/26 422), which accounted for 5% of all endoleaks seen during follow-up. Reinterventions for incident T3EL at follow-up were done in 30 patients (rate 0.1%), which accounted for 9% of endoleak reinterventions and 3.3% of all reinterventions. The presence of incident T3EL found during follow-up was associated with a significant decrease in 5-year survival (74% vs 80%, respectively; p=0.041) in Kaplan-Meier analysis.Conclusion T3ELs rates at placement and follow-up remain low; however, the majority reported in long-term follow-up are incident and these incident endoleaks are associated with decreased survival in EVAR.