预防性肠系膜下动脉栓塞对腹主动脉瘤腔内修复术后结局影响的单中心回顾性分析

Impact of prophylactic inferior mesenteric artery embolization on outcomes after endovascular abdominal aortic aneurysm repair: a single-center retrospective analysis

摘要:

背景与目的 Ⅱ型内漏是腹主动脉瘤腔内修复术（EVAR）后最常见的并发症之一，与术后瘤体持续增大及再干预密切相关。肠系膜下动脉（IMA）是Ⅱ型内漏的重要血流来源，其预防性栓塞的临床价值尚存争议。本研究旨在评估预防性IMA栓塞对EVAR患者术后内漏、瘤体变化及再干预的影响。方法 回顾性分析2022年1月—2024年1月接受EVAR治疗的肾下腹主动脉瘤患者，根据是否行预防性IMA栓塞分为栓塞组和非栓塞组。比较两组患者术前基线资料、围术期情况及随访结局。采用Kaplan-Meier法分析无内漏生存率、无Ⅱ型内漏生存率、免于瘤体增大生存率及免于再干预生存率。结果 共纳入233例患者，其中62例接受预防性IMA栓塞。栓塞组与非栓塞组在术前基线特征及瘤体解剖学参数方面差异无统计学意义（均P>0.05）。平均随访（19.6±9.7）个月。与非栓塞组相比，栓塞组术后2年无内漏生存率（93.55% vs. 74.53，P=0.027）、无Ⅱ型内漏生存率（95.11% vs. 80.02，P=0.043）、无IMA相关Ⅱ型内漏生存率（100.0% vs. 85.26，P=0.019）及免于瘤体增大生存率（94.27% vs. 81.96，P=0.026）均明显提高。两组在术后再干预率方面差异无统计学意义（P=0.388）。结论 预防性IMA栓塞可显著降低EVAR术后内漏，尤其是IMA相关Ⅱ型内漏的发生，并有助于抑制瘤体增大，但对降低再干预率的作用尚不明确，仍需大样本、长期随访研究进一步验证。

Abstract:

Background and Aims Type Ⅱ endoleak remains the most common complication after endovascular aneurysm repair (EVAR) and is closely associated with aneurysmal sac enlargement and secondary interventions. The inferior mesenteric artery (IMA) is a major source of type Ⅱ endoleak; however, the clinical benefit of prophylactic IMA embolization remains controversial. This study aimed to evaluate the impact of prophylactic IMA embolization on postoperative outcomes following EVAR.Methods Patients with infrarenal abdominal aortic aneurysm who underwent EVAR between January 2022 and January 2024 were retrospectively reviewed. Patients were divided into an embolization group and a non-embolization group according to whether prophylactic IMA embolization was performed. Baseline characteristics, perioperative data, and follow-up outcomes were compared. Kaplan-Meier analysis was used to assess endoleak-free survival, type Ⅱ endoleak-free survival, freedom from sac enlargement, and freedom from reintervention.Results A total of 233 patients were included, of whom 62 underwent prophylactic IMA embolization. No significant differences were observed in baseline clinical or anatomical characteristics between the embolization group and a non-embolization group (all P>0.05). During a mean follow-up of (19.6±9.7) months, the embolization group demonstrated significantly higher 2-year endoleak-free survival (93.55% vs. 74.53%, P=0.027), type Ⅱ endoleak-free survival (95.11% vs. 80.02%, P=0.043), IMA-related type Ⅱ endoleak-free survival (100.0% vs. 85.26%, P=0.019), and freedom from aneurysmal sac enlargement (94.27% vs. 81.96%, P=0.026) compared with the non-embolization group. No significant difference was observed in reintervention-free survival between the two groups (P=0.388).Conclusion Prophylactic IMA embolization significantly reduces postoperative endoleaks, particularly IMA-related type Ⅱ endoleaks, and is associated with improved control of aneurysmal sac enlargement after EVAR. However, its effect on reducing reintervention rates remains uncertain and warrants further validation in larger, long-term studies.