Multidisciplinary Endovascular Team, University College Hospital, London, UK.
Br J Surg. 2012 Feb;99(2):152-9. doi: 10.1002/bjs.7804. Epub 2011 Dec 19.
Fenestrated endovascular aneurysm repair (FEVAR) is a technically challenging operation. The duration, blood loss, and risk of limb ischaemia, contrast-induced nephropathy and reperfusion injury are likely to be higher than after standard endovascular aneurysm repair (EVAR). Benefits of FEVAR over open repair may be less than those seen with standard infrarenal EVAR. This paper is a meta-analysis of observational studies of all published data for FEVAR, with the aim to highlight current issues around the evidence for the potential benefit of FEVAR.
A search was performed for studies describing FEVAR for juxtarenal abdominal aortic aneurysms. Small series of fewer than ten procedures and studies describing predominantly branched endografts or FEVAR for aortic dissection were excluded. Authors of included papers were contacted to eliminate patient duplication.
Eleven studies were identified describing a total of 660 procedures. Definitions of aneurysm morphology were variable, and clear inclusion and exclusion criteria were not always documented. Double fenestrations were more common than triple or quadruple fenestrations. Target vessel perfusion rates ranged from 90·5 to 100 per cent. Eleven deaths occurred within 30 days, giving a 30-day proportional mortality rate of 2·0 per cent. Morbidity was poorly reported.
FEVAR for repair of suprarenal and juxtarenal aneurysms is a viable alternative to open repair. However, there is no level 1 evidence for FEVAR, and current evidence is weak with many unanswered questions.
开窗型腔内血管修复术（FEVAR）是一项技术要求较高的手术。手术时长、出血量，以及肢体缺血、对比剂肾病和再灌注损伤的风险可能高于标准腔内血管修复术（EVAR）。与标准肾下 EVAR 相比，FEVAR 的获益可能不及开放修复术。本文对所有发表的 FEVAR 观察性研究数据进行了荟萃分析，旨在强调目前围绕 FEVAR 潜在获益证据的相关问题。
检索描述用于治疗肾周腹主动脉瘤的 FEVAR 的研究。排除了少于 10 例的小系列手术和主要描述分支腔内移植物或 FEVAR 治疗主动脉夹层的研究。联系纳入研究的作者以消除患者重复。
共确定了 11 项描述了总共 660 例手术的研究。动脉瘤形态学的定义存在差异，并且并非总是明确记录纳入和排除标准。双开窗比三开窗或四开窗更常见。靶血管灌注率为 90.5%至 100%。30 天内有 11 例死亡，30 天病死率为 2.0%。发病率报告较差。
FEVAR 用于治疗肾上和肾周动脉瘤是一种可行的开放修复替代方案。然而，目前没有 FEVAR 的一级证据，且现有证据薄弱，存在许多未解决的问题。
