腹主动脉瘤腔内修复术中纤维蛋白粘合剂瘤腔填充技术专家共识

Expert consensus on fibrin sealant aneurysm sac filling during endovascular abdominal aortic aneurysmal repair

摘要:

腹主动脉瘤是老年人群常见的致命性血管疾病，腹主动脉瘤腔内修复术（EVAR）虽已成为首选治疗方式，但术后内漏发生率较高（20%~40%），其中超过30%需要二次干预，严重影响远期疗效。为规范纤维蛋白粘合剂瘤腔填充技术在EVAR术中的应用，中国康复医学会血管外科专业委员会组织多学科专家，依据RIGHT报告规范和GRADE证据分级体系，通过两轮德尔菲法筛选临床问题，结合循证医学证据，形成《腹主动脉瘤腔内修复术中纤维蛋白粘合剂瘤腔填充技术专家共识》。本共识围绕技术适应证与禁忌证、操作流程、剂量估算、术中评估标准、并发症防治及术后随访等关键环节进行系统阐述，明确瘤腔完全填充的判断标准及不同解剖条件下的应用策略。该共识旨在规范临床实践，降低内漏发生率，提高EVAR远期疗效，为血管外科医师提供循证与可操作并重的实践指导。

Abstract:

Abdominal aortic aneurysm is a potentially fatal vascular disease commonly encountered in the elderly population. Although endovascular aneurysm repair (EVAR) has become the preferred treatment modality, the incidence of postoperative endoleaks remains high (20%-40%), with more than 30% of cases requiring secondary interventions, thereby significantly compromising long-term outcomes. To standardize the application of fibrin sealant aneurysm sac filling during EVAR, the Vascular Surgery Professional Committee of the Chinese Association of Rehabilitation Medicine convened a multidisciplinary expert panel. In accordance with the RIGHT reporting guideline and the GRADE evidence grading system, and through two rounds of Delphi surveys to prioritize clinical questions combined with systematic evidence review, the committee developed the Expert consensus on fibrin sealant aneurysm sac filling during endovascular abdominal aortic aneurysmal repair. This consensus systematically addresses key aspects including indications and contraindications, technical procedures, dosage estimation, intraoperative assessment criteria, prevention and management of complications, and postoperative follow-up. It defines criteria for complete sac filling and provides tailored application strategies under various anatomical conditions. The aim of this consensus is to standardize clinical practice, reduce the incidence of endoleaks, improve long-term outcomes after EVAR, and provide vascular surgeons with evidence-informed and practically applicable guidance.