EVAR术后II型内漏的临床管理研究进展

Research Advances in the Clinical Management of Type II Endoleak after Endovascular Aortic Repair

摘要: 目的：综述主动脉瘤腔内修复术(EVAR)后II型内漏(T2EL)临床管理策略的最近研究进展。方法：系统梳理T2EL相关的流行病学特征与自然病程、当前治疗争议，重点对经动脉栓塞(TAE)、直接瘤囊穿刺(DSP)、经腔静脉栓塞(TCE)等介入技术的优劣进行对比，以及讨论弹簧圈、Onyx液体栓塞剂及新型聚合物等栓塞材料的治疗疗效，同时探讨腹腔镜结扎、动脉瘤缝合术及开放手术转换等外科干预方案的可行性与安全性。结果：目前多数研究表明T2EL是EVAR术后常见并发症，多数呈良性病程，对不伴瘤囊增大的孤立性T2EL建议保守观察。但当瘤囊持续扩张时，需考虑积极干预。证据表明，DSP对于TAE多次失败的病例是一种可作为选择的方案。除此之外，对于介入治疗失败的高危患者，微创外科手术及开放手术转流是有效的补救措施。结论：实际临床医生在EVAR术后T2EL的临床决策中，需权衡患者的个体化选择保守观察或积极干预。未来研究应致力于通过前瞻性试验明确干预阈值，并评估新型材料与技术在复杂内漏管理中的远期效益。

Abstract: Purpose: To review recent research advances in the clinical management strategies for Type II Endoleak (T2EL) following Endovascular Aortic Repair (EVAR) for abdominal aortic aneurysm. Methods: We systematically analyzed the epidemiological characteristics and natural history of T2EL, current treatment controversies, and compared the advantages and disadvantages of interventional techniques such as transarterial embolization (TAE), direct sac puncture (DSP), and transcaval embolization (TCE). The therapeutic efficacy of various embolic materials, including coils, Onyx liquid embolic agent, and new polymers, was also discussed. Additionally, the feasibility and safety of surgical interventions like laparoscopic ligation, aneurysmorrhaphy, and conversion to open surgery were explored. Results: Current studies indicate that T2EL is a common complication after EVAR, often following a benign course. Conservative observation is recommended for isolated T2EL without aneurysm sac enlargement. However, intervention is necessary if persistent sac expansion occurs. Evidence suggests that DSP is a viable alternative after multiple failed TAE attempts. Furthermore, minimally invasive surgery and open surgical conversion serve as effective salvage measures for high-risk patients where interventional therapies have failed. Conclusion: In managing T2EL post-EVAR, clinicians must individualize the decision between conservative monitoring and active intervention based on specific patient factors. Future research should focus on defining clear intervention thresholds through prospective trials and evaluating the long-term benefits of novel materials and techniques in managing complex endoleaks.