The association between perioperative embolization of hypogastric arteries and type II endoleaks after endovascular aortic aneurysm repair
The association between perioperative embolization of hypogastric arteries and type II endoleaks after endovascular aortic aneurysm repair
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DOI：
10.1016/j.jvs.2020.04.505
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发表时间：
2021-01-01
影响因子：
4.3
通讯作者：
Komori, Kimihiro
中科院分区：
文献类型：
--
作者：
Meshii, Katsuaki;Sugimoto, Masayuki;Komori, Kimihiro
目的：II型内漏（T2 EL）是动脉瘤腔内修复术（EVAR）后最常见的内漏类型。从腹下动脉发出的髂腰动脉通常是T2 EL的主要来源，有时通过腹下动脉进行髂腰动脉的经动脉栓塞，以在随访期间中断囊扩张。考虑到既往研究中下腹栓塞与T2 EL之间相关性的结果不明确，该主题在髂分支器械出现后再次出现。本研究回顾了我们的系列研究，以澄清腹下动脉栓塞是否与腹主动脉瘤腔内修复术后12个月的T2ELs.Methods相关：回顾性分析了2007年6月至2017年5月在我们机构接受择期腹主动脉瘤腔内修复术的患者。纳入了12个月时接受术后计算机断层扫描血管造影（CTA）的患者。排除了随访期间CTA显示I型或III型内漏、12个月前需要再次介入治疗以及患有孤立性髂动脉瘤的患者。主要结局是腹主动脉瘤腔内修复术后12个月时T2 EL的发生率。分析了患者特征、解剖因素、下腹部栓塞和覆膜支架类型与主要结局的关系。在中位随访59.5个月（四分位距，19126个月）期间，40例患者死亡，并进行了50次再次干预。在108名患者（28.8%）中，对任一腹下动脉进行栓塞，以将远端着陆点延伸至髂外动脉。分别在9名和99名患者中进行了双侧和单侧栓塞。共有153例患者（40.8%）在12个月时通过CTA发现T2 EL。在单变量分析中，有和无T2 EL的患者之间的腹下动脉闭塞或栓塞状态无显著差异。然而，没有足够的患者以>80%的统计功效检测T2 EL的10%差异。在多变量分析中，观察到女性（P = 0.049）、肠系膜下动脉通畅（P = 0.006）和存在5条或更多条通畅腰动脉（P <0.001）与T2 EL显著相关，但与下腹栓塞无关。此外，与Zenith（Cook Medical，布卢明顿，印第安纳州）覆膜支架相比，Excluder（W. L.戈尔联合公司，弗拉格斯塔夫，亚利桑那州）覆膜支架与T2 EL显著相关（P = .001）。结论：在这项缺乏足够统计功效的回顾性研究中，证实了下腹部栓塞与T2 EL之间无显著相关性。（J Vasc Surg 2021;73：99-107.）
Objective: Type II endoleaks (T2ELs) are the most common type of endoleak after endovascular aneurysm repair (EVAR). The iliolumbar artery arising from the hypogastric artery is often a major source of T2ELs, and transarterial embolization of the iliolumbar artery through the hypogastric artery is sometimes performed to interrupt sac expansion during follow-up. Considering the equivocal results of an association between hypogastric embolization and T2ELs in previous studies, this topic has re-emerged after the advent of iliac branch devices. This study reviewed our series to clarify whether hypogastric embolization is associated with T2ELs at 12 months after EVAR.Methods: Patients who underwent elective EVAR between June 2007 and May 2017 at our institution were retrospectively reviewed. Patients with postoperative computed tomography angiography (CTA) at 12 months were included. Patients in whom CTA revealed type I or type III endoleaks during follow-up, who required reinterventions before 12 months, and who had solitary iliac aneurysms were excluded. The primary outcome was the incidence of T2ELs at 12 months after EVAR. The associations of patients' characteristics, anatomic factors, hypogastric embolization, and type of endograft with the primary outcome were analyzed.Results: In total, 375 patients were enrolled. During the median follow-up of 59.5 months (interquartile range, 19126 months), 40 patients died, and 50 reinterventions were performed. In 108 patients (28.8%), either hypogastric artery was embolized to extend distal landings to the external iliac artery. Bilateral and unilateral embolization was performed in nine and 99 patients, respectively. In total, 153 patients (40.8%) had T2ELs found by CTA at 12 months. In the univariate analysis, the status of hypogastric artery occlusion or embolization was not significantly different between patients with and without T2ELs. However, there were not enough patients to detect a 10% difference in T2ELs with >80% statistical power. In the multivariate analysis, significant associations with T2EL were observed for female sex (P = .049), patent inferior mesenteric artery (P = .006), and presence of five or more patent lumbar arteries (P < .001) but not for hypogastric embolization. In addition, compared with the Zenith (Cook Medical, Bloomington, Ind) endograft, the Excluder (W. L. Gore & Associates, Flagstaff, Ariz) endograft was significantly related to T2EL (P = .001).Conclusions: No significant association between hypogastric embolization and T2EL was demonstrated in this retrospective study, which lacked adequate statistical power. (J Vasc Surg 2021;73:99-107.)