Comparison of Treatment Outcomes between Graft Replacement and Aneurysmorrhaphy with Graft Preservation for Type 2 Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair

IF 1.6 4区医学 Q3 PERIPHERAL VASCULAR DISEASE Annals of vascular surgery Pub Date : 2025-04-01 Epub Date: 2025-01-27 DOI:10.1016/j.avsg.2025.01.015

Koichi Morisaki , Shinichiro Yoshino , Daisuke Matsuda , Shun Kurose , Jun Okadome , Ken Nakayama , Ryosuke Yoshiga , Kentaro Inoue , Tadashi Furuyama , Terutoshi Yamaoka , Masazumi Kume , Takuya Matsumoto , Jin Okazaki , Hiroyuki Ito , Toshihiro Onohara , Tomoharu Yoshizumi

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Abstract

Background

This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms.

Methods

We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion.

Results

Forty patients underwent open surgical conversion (graft replacement, n = 9; graft preservation, n = 31). There were no significant differences in patient characteristics at open surgical conversion or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < 0.001, and 710 vs. 2,567 mL, P = 0.030, respectively). There was no difference in the occurrence of postoperative complications between the 2 groups (P = 0.645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = 0.789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = 0.239).

Conclusion

Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.

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血管内腹主动脉瘤修复术后2型内溢动脉瘤置换术与保存动脉瘤吻合术治疗效果比较。

目的：本研究旨在比较血管内动脉瘤修复（EVAR）后2型腹主动脉瘤内漏的移植物置换与主动脉侧分支结扎术的治疗效果。方法：我们回顾性分析了2007年至2022年间接受开放手术转换的患者的多中心数据，包括移植物置换术或动脉瘤缝合术合并主动脉侧分支结扎（移植物保存）治疗2型内漏。终点是术后并发症、30天死亡率、总生存率和开放手术转换后的再干预或囊囊扩张。结果：40例患者行开放性手术(移植物置换术，n=9；移植物保存，n=31)。两组之间在患者特征或初始EVAR的解剖数据上没有显著差异。移植物保存组的中位手术时间和出血量均显著少于替代组（179 vs 318 min, P < 0.001; 710 vs 2567 mL, P = 0.030）。两组术后并发症发生率差异无统计学意义（P = .645）。在任何组中均未观察到30天死亡率。开放手术转换后5年的总生存率，移植物置换组为85.7%，移植物保存组为77.8% （P = .789）。开放手术转换后5年，移植物置换组无囊扩张或再干预率为100%，移植物保存组为76.0% （P = 0.239）。结论：主动脉侧支结扎动脉瘤术与置换术相比侵入性更小，但术后并发症无差异。移植物置换术后无需再干预；然而，一些患者在移植物保存后需要再次干预。需要进一步的研究来确定治疗2型内漏的最佳手术方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence