Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the managem...Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.展开更多
Background:To report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases(ICAVDs)using Willis covered st...Background:To report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases(ICAVDs)using Willis covered stents.METHODS:Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed.The clinical data of endoleak management and postoperative surveillance were analyzed.RESULTS:Seventy-three cases with ICAVD,including 57 aneurysms,11 carotid-cavernous sinus fistulas(CCF),and 5 surgical injuries,were all successfully installed with covered stents.Total isolation of ICAVDs was achieved in 59 patients(80.8%),and endoleaks were observed in 14 patients(19.2%).Of the 14 patients with endoleaks,12 had type I endoleaks and 2 had type II;13 had aneurysms and one had CCF.10 patients with type I endoleaks received balloon dilatation,and 7 of them underwent a second stent-graft implantation after then.One patient with type II endoleak received embolization of the branch artery,and another one received follow-up observation.Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation.During the follow-up period,minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture.CONCLUSIONS:Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure.Improving the understanding and management of endoleaks can be beneficial in the clinical setting,including the popularization and application of this technique.展开更多
Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm ...Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.展开更多
Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （...Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.展开更多
Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.
We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surve...We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal lilac artery feeding the fourth lumbar artery.展开更多
文摘Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.
基金supported by the Project from Shanghai Natural Science Fund Project(Grant no.19ZR1449000)Training Program of Shanghai Tongji hospital(Grant no.GJPY1812 and ITJ(ZD)1907)+1 种基金Shanghai“Rising Stars of Medical Talent”Youth Development Program(Grant no.[2019]72)Program of Outstanding Young Scientists of Tongji Hospital of Tongji University no.HBRC1808。
文摘Background:To report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases(ICAVDs)using Willis covered stents.METHODS:Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed.The clinical data of endoleak management and postoperative surveillance were analyzed.RESULTS:Seventy-three cases with ICAVD,including 57 aneurysms,11 carotid-cavernous sinus fistulas(CCF),and 5 surgical injuries,were all successfully installed with covered stents.Total isolation of ICAVDs was achieved in 59 patients(80.8%),and endoleaks were observed in 14 patients(19.2%).Of the 14 patients with endoleaks,12 had type I endoleaks and 2 had type II;13 had aneurysms and one had CCF.10 patients with type I endoleaks received balloon dilatation,and 7 of them underwent a second stent-graft implantation after then.One patient with type II endoleak received embolization of the branch artery,and another one received follow-up observation.Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation.During the follow-up period,minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture.CONCLUSIONS:Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure.Improving the understanding and management of endoleaks can be beneficial in the clinical setting,including the popularization and application of this technique.
文摘Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.
文摘Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.
文摘Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.
文摘We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal lilac artery feeding the fourth lumbar artery.
