Di Xiao, Ye Wei, Liu Chang-Wei, Jiang Jingmei, Han Wei, Liu Bao
Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Ann Vasc Surg. 2013 Nov;27(8):1190-200. doi: 10.1016/j.avsg.2013.06.003. Epub 2013 Aug 22.
The development of endovascular technology has led to the introduction of fenestrated endovascular repair (f-EVAR) to treat pararenal abdominal aortic aneurysms (PRAAAs) that have been deemed unsuitable for standard endovascular repair. We performed a systematic review and meta-analysis of data from the literature to determine the outcomes of the fenestrated technology.
The MEDLINE, EMBASE, and Cochrane databases were searched to identify all studies published in English between January 1996 and May 2011 that reported on f-EVAR for PRAAAs. Separate meta-analyses were performed for primary outcomes (i.e., 30-day mortality, technical success rate, primary target vessel patency rate, and 12-month patency rate) and secondary outcomes (i.e., reintervention rate, target renal artery occlusion rate, and postoperative permanent dialysis rate). Subgroup analyses were performed to determine whether there were differences in outcomes between varying types of studies (prospective or retrospective). Regression analyses were performed to explore associations between outcomes and varying factors (i.e., mid-date of study, study size, and procedure time).
Twelve studies conducted between 2006 and 2011 and consisting of a total of 776 cases of f-EVAR were enrolled. The pooled estimate for 30-day mortality was 2.52% (95% confidence interval [CI]: 1.55-4.08). Technical success was measured to be 92.8% (95% CI: 87.5-96.0). Primary target vessel patency was 98.3% (95% CI: 97.4-98.8). Twelve-month target vessel patency was 94.5% (95% CI: 92.1-96.2). The postoperative reintervention rate was 17.6% (95% CI: 12.0-25.1). The target renal artery occlusion rate was 6.1% (95% CI: 4.1-8.8). The postoperative permanent dialysis rate was 2.6% (95% CI: 1.5-4.4). Subgroup analyses found no significant differences between the major outcomes of the retrospective studies and the prospective studies. Regression analyses suggested that large series had higher 12-month target vessel patency rates than small series.
This study revealed that f-EVAR treatment for PRAAAs has acceptable early and mid-term outcomes.
血管内技术的发展促使开窗血管内修复术（f-EVAR）被用于治疗被认为不适于标准血管内修复术的肾旁腹主动脉瘤（PRAAA）。我们对文献数据进行了系统评价和荟萃分析，以确定开窗技术的治疗效果。
检索MEDLINE、EMBASE和Cochrane数据库，以识别1996年1月至2011年5月期间发表的所有关于f-EVAR治疗PRAAA的英文研究。对主要结局（即30天死亡率、技术成功率、主要靶血管通畅率和12个月通畅率）和次要结局（即再次干预率、靶肾动脉闭塞率和术后永久性透析率）分别进行荟萃分析。进行亚组分析以确定不同类型研究（前瞻性或回顾性）之间的结局是否存在差异。进行回归分析以探讨结局与不同因素（即研究中期、研究规模和手术时间）之间的关联。
纳入了2006年至2011年期间进行的12项研究，共776例f-EVAR病例。30天死亡率的合并估计值为2.52%（95%置信区间[CI]：1.55-4.08）。技术成功率为92.8%（95%CI：87.5-96.0）。主要靶血管通畅率为98.3%（95%CI：97.4-98.8）。12个月靶血管通畅率为94.5%（95%CI：92.1-96.2）。术后再次干预率为17.6%（95%CI：12.0-25.1）。靶肾动脉闭塞率为6.1%（95%CI：4.1-8.8）。术后永久性透析率为2.6%（95%CI：1.5-4.4）。亚组分析发现回顾性研究和前瞻性研究的主要结局之间无显著差异。回归分析表明，大样本系列的12个月靶血管通畅率高于小样本系列。
本研究表明，f-EVAR治疗PRAAA具有可接受的早期和中期疗效。
