目的: 探讨腹主动脉瘤（abdominal aortic aneurysm, AAA）腔内修复术后发生内漏的危险因素。方法: 回顾性分析2014年1月至2015年10月272例AAA病人行腔内修复术的临床资料和术后3、6、12、24、36个月随访结果。分析腔内修复术后各型内漏发生率及其与临床特征、支架类型、动脉瘤颈结构的关系。结果: 272例病人腔内修复术后内漏总发生率为15.8%(43/272),其中Ⅰ、Ⅱ、Ⅲ或Ⅳ型以及张力性内漏（Ⅴ型）的发生率分别为7.4%(20/272)、6.3%(17/272)、1.5%(4/272)和0.7%(2/272)。Ⅰ型内漏多在随访3个月时发现,而其他类型内漏在随访12个月或更晚发现。动脉瘤近端瘤颈短（<1.5 cm）、重度扭曲（>45°）、形状不规则或钙化程度高（>25%）与Ⅰa型内漏发生显著相关（P<0.05）。持续通畅的肠系膜下动脉以及存在≥2根罪犯血管是Ⅱ型内漏发生的危险因素（P<0.05）。年龄、美国麻醉医师协会（American Society of Anesthesiologists, ASA）病情分级、吸烟以及合并高血压、糖尿病、冠心病、肺部疾病等对内漏发生率无影响。不同类型的人工血管支架对内漏发生有显著影响（P=0.047）。与其他类型支架相比,Endurant支架的内漏发生率最低（10.7%）。结论: 制定腔内修复手术方案时,应充分评估AAA的特征和内漏风险,以期达到较好的疗效。
Objective: To investigate the risk factors for endoleaks after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: A total of 272 patients with AAA undergoing EVAR from January 2014 to October 2015 were retrospectively analyzed. The patients were followed up at postoperative 3, 6, 12, 24, and 36 months. The endoleak incidence and the association of endoleak with clinical characteristics, stent graft type and anatomic geometry of aneurysm neck were analyzed. Results: The incidence of endoleaks after EVAR in 272 patients with AAA was 15.8% (43/272) with 7.4% (20/272), 6.2% (17/272), 1.5% (4/272) and 0.7% (2/272) for type Ⅰ, Ⅱ, Ⅲ+Ⅳ and Ⅴ (endotension), respectively-Type Ⅰ endoleak was found mostly during 3-month of follow-up, and the other endoleaks during 12-month of follow-up or longer. Short proximal neck length of aneurysm (<1.5 cm), oversize degree (>45°), irregular shape, and high calcification (>25%) were significantly associated with an increased incidence of type Ⅰa endoleak (P<0.05). Patent inferior mesenteric artery and ≥2 crime arteries were the risk factors for type Ⅱ endoleak (P<0.05). Clinical characteristics, including age, ASA status, smoking status, and comorbidities such as hypertension, diabetes, coronary artery disease and pulmonary disease had no impact on endoleak. However, stent graft type was associated with the incidence of overall endoleak significantly (P=0.047). Endurant showed to be used with the lowest incidence of endoleak (10.7%) when compared with other stent graft types. Conclusions: To avoid endoleak, physicians should evaluate the characteristics of AAA and assess the risks for endoleak when planning an EVAR.
[1] Kent KC.Clinical practice. Abdominal aortic aneurysms[J]. N Engl J Med,2014,371(22):2101-2108.
[2] van Beek SC, Conijn AP, Koelemay MJ, et al. Editor's Choice - Endovascular aneurysm repair versus open repair for patients with a ruptured abdominal aortic aneurysm: a systematic review and meta-analysis of short-term survival[J]. Eur J Vasc Endovasc Surg,2014,47(6):593-602.
[3] Health Quality Ontario.Endovascular repair of abdominal aortic aneurysm: an evidence-based analysis[J]. Ont Health Technol Assess Ser,2002,2(1):1-46.
[4] Kuziez MS, Sanchez LA, Zayed MA. Abdominal aortic aneurysm type Ⅱ endoleaks[J]. J Cardiovasc Dis Diagn,2016,4(5).pii:255.
[5] Shen A, Ologun GO, Keller H, et al.Natural history of an untreated type 1 endoleak: a case report[J]. Cureus,2017,9(7):e1507.
[6] Hellinger JC.Endovascular repair of thoracic and abdominal aortic aneurysms: pre- and postprocedural ima-ging[J]. Tech Vasc Interv Radiol,2005,8(1):2-15.
[7] Veith FJ, Baum RA, Ohki T, et al.Nature and significance of endoleaks and endotension: summary of opi-nions expressed at an international conference[J]. J Vasc Surg,2002,35(5):1029-1035.
[8] Buth J, Harris PL, van Marrewijk C, et al. The significance and management of different types of endoleaks[J]. Semin Vasc Surg,2003,16(2):95-102.
[9] Schurink GW, Aarts NJ, van Bockel JH. Endoleak after stent-graft treatment of abdominal aortic aneurysm: a meta-analysis of clinical studies[J]. Br J Surg,1999,86(5):581-587.
[10] Frego M, Lumachi F, Bianchera G, et al.Risk factors of endoleak following endovascular repair of abdominal aortic aneurysm. A multicentric retrospective study[J]. In Vivo,2007,21(6):1099-1102.
[11] Mohan IV, Laheij RJ, Harris PL, et al.Risk factors for endoleak and the evidence for stent-graft oversizing in patients undergoing endovascular aneurysm repair[J]. Eur J Vasc Endovasc Surg,2001,21(4):344-349.
[12] Duffy JM, Rolph R, Waltham M. Stent graft types for endovascular repair of abdominal aortic aneurysms[J]. Cochrane Database Syst Rev,2015,(9):CD008447.
[13] Petrik PV, Moore WS.Endoleaks following endovascular repair of abdominal aortic aneurysm: the predictive value of preoperative anatomic factors--a review of 100 cases[J]. J Vasc Surg,2001,33(4):739-744.
[14] Makaroun M, Zajko A, Sugimoto H, et al.Fate of endoleaks after endoluminal repair of abdominal aortic aneurysms with the EVT device[J]. Eur J Vasc Endovasc Surg,1999,18(3):185-190.
[15] Sampaio SM, Panneton JM, Mozes GI, et al.Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: predictive factors[J]. Ann Vasc Surg,2004,18(6):621-628.
[16] Ward TJ, Cohen S, Patel RS, et al.Anatomic risk factors for type-2 endoleak following EVAR: a retrospective review of preoperative CT angiography in 326 patients[J]. Cardiovasc Intervent Radiol,2014,37(2):324-328.
[17] Lo RC, Buck DB, Herrmann J, et al.Risk factors and consequences of persistent type Ⅱ endoleaks[J]. Vasc Surg,2016,63(4):895-901.
