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Abstract：
Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period. Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
摘要：
背景/目的：本系统综述旨在探讨腹腔镜肠系膜下动脉结扎（IMA）的有效性和安全性，这是解决腔内主动脉瘤修复（EVAR）后II型内漏的新兴趋势。方法：在包括Medline在内的多个数据库中进行了全面的文献检索，Scopus,和Cochrane中央控制试验登记册，遵守PRISMA准则。搜索的重点是报道IMA腹腔镜结扎治疗EVAR后II型内漏的文章。提取有关研究特征的数据，患者人口统计学，技术成功率,术后结果,和后续结果。结果：我们的分析包括十项病例研究和两项回顾性队列研究，包括2000年至2023年期间接受了IMA腹腔镜结扎术的26例患者。该队列的平均年龄为72.3岁，男性占主导地位（92.3%）。介入时的平均AAA直径为69.7mm。该技术具有92.3%的高技术成功率,平均手术时间为118.4分钟，失血最少。平均随访时间为19.9个月,73%的患者经历了动脉瘤囊的消退，在随访期间没有IMA相关的II型内漏的报告。结论：IMA腹腔镜结扎术治疗EVAR后II型内漏是一种有前途的方法，具有较高的技术成功率和良好的术后结局的微创替代方案。尽管它有潜在的优势,包括减少造影剂的使用和辐射暴露，它的应用仍然限于专业中心。研究结果表明，需要在更大的前瞻性研究中进行进一步研究，以验证该程序的有效性，并有可能扩大其临床应用范围。
