内漏是移植物外动脉瘤囊内的持续血流。[146]Schurink GW, Aarts NJ, vanBockel JH. Endoleak after stent-graft treatment of abdominal aortic aneurysm: a meta-analysis of clinical studies. Br J Surg. 1999 May;86(5):581-7.[147]Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002 May;35(5):1029-35. 这并不是开放修复术后的并发症。
术后监测可以检测到主要内漏和动脉瘤囊扩张。腔内动脉瘤修复术 (EVAR) 后出现内漏的风险为 24%。[146]Schurink GW, Aarts NJ, vanBockel JH. Endoleak after stent-graft treatment of abdominal aortic aneurysm: a meta-analysis of clinical studies. Br J Surg. 1999 May;86(5):581-7.
I 型：临床上明显；在完成手术前，应尽一切努力修复 I 型内漏（例如近端密封区域的球囊模制、放置近端套囊和内缝合器 [endostaple]）。持久性 IA 型内漏可能需要先进行转换才能进行开放修复术。[56]Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext
[Figure caption and citation for the preceding image starts]: 支架的延长同样用于 I 型内漏（已圈出）密歇根大学 (University of Michigan)，具体是血管外科和放射科 Dr Upchurch 的病例 [Citation ends].
[Figure caption and citation for the preceding image starts]: 延长后 I 型内漏消失密歇根大学 (University of Michigan)，具体是血管外科和放射科 Dr Upchurch 的病例 [Citation ends].
II 型：治疗仍存在争议，但如果术后 6 至 12 个月持续存在内漏或动脉瘤囊增大，以致近端和/或远端密封区域可能受到损害，则建议进行治疗。[149]Mansueto G, Cenzi D, Scuro A, et al. Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up. J Vasc Surg. 2007 Jun;45(6):1120-7.[150]Baum RA, Stavropoulos SW, Fairman RM, et al. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 1):1111-7.[151]Van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004 Feb;27(2):128-37.[152]Harris PL, Vallabhaneni SR, Desgranges P, et al. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. J Vasc Surg. 2000 Oct;32(4):739-49. 首选治疗方案是经动脉弹簧圈栓塞，但也有使用腹腔镜结扎侧支、对囊进行直接经皮经腰穿刺术、经腰栓塞术、经腔静脉导管栓塞术进行治疗的报告。[147]Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002 May;35(5):1029-35.[149]Mansueto G, Cenzi D, Scuro A, et al. Treatment of type II endoleak with a transcatheter transcaval approach: results at 1-year follow-up. J Vasc Surg. 2007 Jun;45(6):1120-7.[150]Baum RA, Stavropoulos SW, Fairman RM, et al. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 1):1111-7.[151]Van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004 Feb;27(2):128-37.[153]Steinmetz E, Rubin BG, Sanchez LA, et al. Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg. 2004 Feb;39(2):306-13.[154]Baum RA, Cope C, Fairman, et al. Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2001 Jan;12(1):111-6.[155]Baum RA, Carpenter JP, Golden MA, et al. Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg. 2002 Jan;35(1):23-9.[156]Schmid R, Gurke L, Aschwanden M, et al. CT-guided percutaneous embolization of a lumbar artery maintaining a type II endoleak. J Endovasc Ther. 2002 Apr;9(2):198-202.
III 型：发现后适合行修复术（延长血管内支架移植物）。[56]Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext[150]Baum RA, Stavropoulos SW, Fairman RM, et al. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 1):1111-7.
IV 型：使用新型的支架移植物造成的渗漏少见，且具有自限性，不需要治疗。[56]Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext[150]Baum RA, Stavropoulos SW, Fairman RM, et al. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 1):1111-7.
V 型（内张力）：在新一代移植支架中更少见；[56]Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext 动脉瘤未增大的情况下，没有测量内张力的标准方法，也没有治疗适应证的共识；然而，对于动脉瘤持续扩张的部分患者，建议对增高的内张力进行治疗，防止动脉瘤破裂。[56]Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.http://www.jvascsurg.org/article/S0741-5214(17)32369-8/fulltext[147]Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002 May;35(5):1029-35.
气管插管的动画演示
球囊面罩通气的动画演示
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