【摘要】 动脉瘤腔内修复术（EVAR）是治疗腹主动脉瘤（AAA）的重要手段，但术后Ⅱ型内漏（T2EL）是最常见的并发症之一。T2EL主要由肠系膜下动脉（IMA）和腰动脉（LA）等侧支血管的反流血持续灌注动脉瘤囊所致。尽管T2EL可能导致瘤囊增大甚至破裂，但其总体危害较小，大多数病例可通过观察或微创手术进行有效处理。目前，预防性栓塞IMA和LA在降低T2EL发生率方面的效果尚不明确，且可能增加手术时间、辐射剂量和相关并发症发生风险。更重要的是，国内外权威指南均未推荐EVAR术中常规进行IMA和LA的预防性栓塞。针对T2EL高风险患者是否应进行预防性栓塞仍存争议，且相关研究多为小样本或单中心回顾性分析，证据级别有限。本文结合现有研究，从T2EL的危害性、预防性栓塞的效果及其临床指南推荐等方面进行总结分析，以期为EVAR术后T2EL的个体化管理提供参考依据。更多还原

【Abstract】 Endovascular aneurysm repair (EVAR) is a key treatment for abdominal aortic aneurysms (AAA),but typeⅡendoleak (T2EL) is one of the most common postoperative complications.T2EL mainly arises from retrograde blood flow from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA),which continue to perfuse the aneurysm sac.Although T2EL may lead to aneurysm sac enlargement or even rupture,its overall clinical impact is relatively minor,and most cases can be effectively managed through observation or minimally invasive interventions.Currently,the efficacy of prophylactic embolization of the IMA and LA in reducing the incidence of T2EL remains uncertain and may increase operative time,radiation exposure,and the risk of associated complications.More importantly,authoritative guidelines,both domestic and international,do not recommend routine prophylactic embolization of the IMA and LA during EVAR.Whether prophylactic embolization should be performed in high-risk patients for T2EL remains controversial,with most studies in this area being small-sample or single-center retrospective analyses,offering limited evidence quality.This article analyzes the harm of T2EL,the effectiveness of prophylactic embolization,and relevant guideline recommendations based on existing research,aiming to provide a reference for the individualized management of T2EL following EVAR.更多还原