Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: Predictive factors
Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: Predictive factors
复制标题
DOI：
10.1007/s10016-004-0100-z
复制
发表时间：
2004-11-01
影响因子：
1.5
通讯作者：
Gloviczki, P
中科院分区：
文献类型：
--
作者：
Sampaio, SM;Panneton, JM;Gloviczki, P
腹主动脉瘤腔内修复术（EVAR）后的近端I型内漏与高破裂风险相关。发生这种并发症的风险因素尚未完全阐明。我们的目的是确定近端I型内漏的术前预测因素并描述其临床结局。从257例接受腹主动脉瘤腔内修复术的患者的连续系列中，我们选择了202例有可用的术前和术后CT扫描研究的患者。通过术前CT扫描评价近端瘤颈直径、长度、成角、钙化、血栓负荷（厚度、瘤颈周长覆盖百分比、瘤颈面积占用百分比）和最大动脉瘤直径。审查了所有术后CT和多普勒超声扫描，并在选定病例中补充血管造影片，以确定是否存在内漏。还确定了器械重叠和尺寸过大（相对于近端颈部）。使用Kaplan-Meier方法估计I型近端内漏率。使用考克斯比例风险模型评价了上述变量与近端I型内漏之间的相关性。8例患者发生近端I型内漏，相当于3年发生率为4%（SE = 1.5%）。中位随访时间为340天（范围：22-1954）。单变量分析发现近端I型内漏与以下变量之间存在显著相关性：颈围钙化百分比（风险比= 2.19，增加25%，p = 0.019），动脉瘤最大直径（风险比= 1.98，增加1 cm，p = 0.006）和近端瘤颈与器械重叠（风险比= 0.53，增加5 mm，p = 0.007）。有和无I型近端内漏病例的平均重叠分别为15.6 mm和29.3 mm。当这些变量纳入多变量模型时，所有变量均保持统计学显著性。未记录到颈部血栓相关变量的显著相关性。39例（19.3%）患者的β颈角低于120 °。在这些患者中，近端I型内漏的发生率有较高的趋势（p = 0.057）。相对于近端颈部直径的器械尺寸过大不会影响此类内漏的概率。一名患者在显著扩张后存活于破裂动脉瘤的紧急开放修复术中。6例患者接受血管内再介入（4例额外近端套囊置入，2例近端血管成形术）。再次介入的平均间隔为389天。4例（50%）发现远端移位（大于或等于5 mm）。近端I型内漏是腹主动脉瘤腔内修复术后的罕见并发症，但与大量再介入和潜在严重后果相关。短且严重钙化的动脉瘤颈和大动脉瘤患者发生近端I型内漏的风险增加。
Proximal type I endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) are associated with a high risk of rupture. Risk factors for developing this complication are not fully elucidated. We aimed to define preoperative predictors for proximal type I endoleak and describe its clinical outcome. From a consecutive series of 257 patients who underwent EVAR, we selected 202 who had available pre- and postoperative CT scan studies. Proximal neck diameter, length, angulation, calcification, thrombus load (thickness, percentage of neck circumference coverage, percentage of neck area occupancy), and maximum aneurysm diameter were evaluated on preoperative CT scans. All postoperative CT and duplex ultrasound scans, supplemented with angiograms in selected cases, were reviewed for the presence or absence of endoleak. Device overlap and oversizing (relative to the proximal neck) were also determined. Type I proximal endoleak rates were estimated using the Kaplan-Meier method. The associations between the variables listed above and proximal type I endoleak were evaluated by use of Cox proportional hazards models. Proximal type I endoleak occurred in eight patients, corresponding to a 3-year incidence rate of 4% (SE = 1.5%). The median follow-up was 340 days (range, 22-1954). Univariate analyses found significant associations between proximal type I endoleak and the following variables: percentage of calcified neck circumference (hazards ratio = 2.19 for a 25% increase, p = 0.019), aneurysm maximum diameter (hazards ratio = 1.98 for a 1-cm increase, p = 0.006) and proximal neck and device overlap (hazards ratio = 0.53 for a 5-mm increase, p = 0.007). The mean overlap among cases with and without type I proximal endoleak was 15.6 mm and 29.3 mm, respectively. When these variables were included in a multivariate model, all remained statistically significant. No significant association could be documented for neck thrombus-related variables. Thirty-nine (19.3%) patients had a beta neck angle inferior to 120degrees. There was a trend toward a higher incidence of proximal type I endoleaks in these patients (p = 0.057). Device oversize relative to proximal neck diameter did not affect the probability of this type of endoleak. One patient survived an emergency open repair of a ruptured aneurysm after significant expansion. Six patients underwent endovascular reinterventions (4 additional proximal cuff placements, 2 proximal angioplasties). The mean interval for reintervention was 389 days. Distal migration (greater than or equal to5 mm) was identified in four cases (50%). Proximal type I endoleak is a rare complication after EVAR, but it is associated with a high number of reinterventions and potentially serious consequences. Patients with short and heavily calcified aneurysmal necks and large aneurysms are at increased risk of proximal type I endoleaks.