腹主动脉瘤腔内修复术后Ⅱ型内漏的临床分析
Relative factors of type Ⅱ endoleak after endovascular aneurysm repair

目的：探讨腹主动脉瘤腔内修复术后Ⅱ型内漏的相关因素。方法：回顾28例腹主动脉瘤腔内修复术后的内漏发生情况及转归，分析Ⅱ型内漏病例的肠系膜下动脉、Riolan弓以及腰动脉的特点。结果：28例中有8例（28.6%）发生Ⅱ型内漏，其中Ⅱa型2例，Ⅱb型6例。形成内漏的肠系膜下动脉起始部直径［平均(4.03±1.00) mm］明显大于未形成内漏者［平均(2.89±0.50) mm，P=0.007］；发生Ⅱ型内漏病例的瘤腔发出腰动脉支数［平均(3.4±0.8)支］明显多于无内漏者［平均(1.9±1.5)支，P=0.017］；内漏的形成与腰动脉起始部直径、Riolan弓形态不相关。平均随访14.5个月，8例Ⅱ型内漏中1例瘤腔缩小，2例无变化，5例增大，其中仅1例增大明显而接受栓塞治疗。结论：增强CT静脉期延迟扫描可更好地发现低流量内漏，肠系膜下动脉起始部直径越粗大，从瘤腔直接发出的腰动脉越多，越易形成Ⅱ型内漏。对于Ⅱ型内漏动脉瘤腔明显增大者，应积极栓塞治疗。
Objective：To study the relative factors of type Ⅱ endoleak after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Methods: Twenty-eight cases of abdominal aortic aneurysms treated by EVAR were retrospectively analyzed. The characteristics of the inferior mesentery arteries (IMA), the arc Riolan and the lumbar arteries of the cases with or without type Ⅱ endoleak were analyzed. Results: Type Ⅱ endoleak was found in 8 (28.6%) cases, of which, 2 were type Ⅱa and 6 were type Ⅱb. The diameter of the IMA originating part of the cases with type Ⅱ endoleak ［(4.03±1.00) mm］ was significantly bigger than that without endoleak ［(2.89±0.50) mm, P=0.007］. The number of the lumbar arteries originating from the aneurysm sac in cases with type Ⅱ endoleak (3.4±0.8) was significantly more than that without endoleak (1.9±1.5, P=0.017). However, type Ⅱ endoleak was irrelevant to the diameter of originating part of the lumbar arteries and the form of the arc Riolan. After the average 14.5 months follow-up, the aneurysm sac was found with shrinkage in 1 case, no change in 2 cases, and augment in 5 cases. Secondary transarterial embolization was performed for only 1 case. Conclusion: Type Ⅱ endoleak was much easily found in cases with bigger diameter of originating part of the IMA, or in cases with more lumbar arteries originating from the aneurysm sac.