Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
J Vasc Surg. 2012 Jul;56(1):238-46. doi: 10.1016/j.jvs.2011.10.092. Epub 2012 Jan 21.
We performed a systematic review of the current literature to analyze the immediate and follow-up results of fenestrated endovascular aortic aneurysm repair (F-EVAR) in patients with pararenal abdominal aortic aneurysms (AAAs).
The Medline, Embase, and Cochrane databases were searched to identify all studies reporting F-EVAR of pararenal AAAs published between January 2000 and May 2011. Two independent observers selected studies for inclusion, assessed the quality of the included studies, and performed the data extraction. Studies were selected based on specific predefined criteria. Outcomes were technical success (successfully completed procedure with endograft patency, preservation of target vessels, and no evidence of type I or III endoleak at postprocedural imaging), 30-day mortality, all-cause mortality, branch vessel patency, renal impairment, and secondary interventions. Between-study heterogeneity was calculated using I(2) statistics. Pooled estimates were calculated using a fixed-effects (I(2) <25%) or a random-effects (I(2) >25% to <50%) model.
Nine studies were included reporting 629 patients who underwent F-EVAR for a pararenal AAA, of which 1622 target vessels were incorporated in an endograft design. Between-study heterogeneity was ≤ 41% for all outcomes. The pooled estimate (95% confidence interval [CI] was 90.4% (87.7%-92.5%) for technical success, 2.1% (1.2%-3.7%) for 30-day mortality, and 16% (12.5%-20.4%) for all-cause mortality. Follow-up was 15 to 25 months. The pooled estimate (95% CI) during follow-up was 93.2% (90.4%-95.3%) for branch vessel patency, 22.2% (16%-30.1%) for renal impairment, and 17.8% (13.5%-22.6%) for secondary interventions.
Promising immediate and midterm results (up to 2 years) support F-EVAR as a feasible, safe, and effective treatment in a relatively high-risk cohort of patients with pararenal AAAs.
我们对当前文献进行了系统综述，以分析腔内修复治疗肾周腹主动脉瘤（AAA）的即刻和随访结果。
检索 Medline、Embase 和 Cochrane 数据库，以确定 2000 年 1 月至 2011 年 5 月间发表的所有关于腔内修复治疗肾周 AAA 的研究。两名独立观察员选择纳入研究，评估纳入研究的质量，并提取数据。研究根据特定的预设标准进行选择。结果为技术成功率（成功完成手术，移植物通畅，目标血管通畅，术后影像学无 I 型或 III 型内漏）、30 天死亡率、全因死亡率、分支血管通畅率、肾功能不全和二次干预。使用 I(2)统计量计算研究间异质性。使用固定效应模型（I(2) <25%）或随机效应模型（I(2) >25%至 <50%）计算汇总估计值。
纳入了 9 项研究，共 629 例患者接受了肾周 AAA 的腔内修复治疗，其中 1622 个靶血管被纳入移植物设计。所有结果的研究间异质性均≤41%。汇总估计值（95%置信区间）为技术成功率 90.4%（87.7%-92.5%）、30 天死亡率 2.1%（1.2%-3.7%）和全因死亡率 16%（12.5%-20.4%）。随访时间为 15 至 25 个月。随访期间的汇总估计值（95%CI）为分支血管通畅率 93.2%（90.4%-95.3%）、肾功能不全率 22.2%（16%-30.1%）和二次干预率 17.8%（13.5%-22.6%）。
有前途的即刻和中期（长达 2 年）结果支持腔内修复治疗肾周 AAA，这是一种在相对高危的肾周 AAA 患者中可行、安全和有效的治疗方法。
