Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece; ; The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia.
Ann Cardiothorac Surg. 2012 Sep;1(3):267-76. doi: 10.3978/j.issn.2225-319X.2012.08.02.
A combined open-endovascular technique has emerged as an alternative treatment option for thoracoabdominal pathologies. However, reported experiences from various medical centers have been contradictory and heterogeneous. The aim of this study is to assess the mortality rate and various complication rates associated with this approach.
An electronic health database search was performed on all articles published up to March of 2012 describing combined open-endovascular repair of thoracoabdominal pathologies. Studies were included in the meta-analysis if they had ≥10 patients and reported the basic outcome criteria. End points of the meta-analysis were defined as primary technical success, endoprosthesis related complications, 30-day/in-hospital mortality, symptoms of spinal cord ischemia (SCI) and irreversible paraplegia, permanent renal function impairment, and other major complications.
Fourteen studies were deemed eligible for this meta-analysis with a total of 528 patients (68.0% male, mean age 70.5 years). The mean follow-up period was 34.2 months. The pooled estimate for primary technical success and visceral graft patency was 95.4% and 96.5% respectively. An endoleak developed in 106 (21.1%) patients in whom both stages had been completed. The pooled rate for symptomatic SCI was 7.0% and for irreversible paraplegia 4.4%. The pooled proportion for permanent renal failure was 7.0% and for mesenteric ischemia 4.5%. Prolonged respiratory support and cardiac complications were observed in a pooled rate of 7.8% and 4.6% respectively. The meta-analysis for 30-day/in-hospital mortality revealed a pooled rate of 14.3%.
Although the hybrid technique for thoracoabdominal aortic pathology provides a less invasive approach, the technique is still associated with a considerable morbidity and mortality rates. High risk patients unfit to withstand open repair, are equally likely to suffer significant complications with the hybrid procedure. The choice of the optimal treatment strategy for thoracoabdominal pathologies should be carefully made on a patient to patient basis, assessing the clinical fitness and the anatomical suitability of each patient. The hybrid approach should be reserved for high volume centers with accumulated experience and high standards of perioperative management.
开放式血管内联合技术已成为治疗胸腹主动脉疾病的一种替代治疗选择。然而，来自不同医疗中心的报告经验相互矛盾且存在差异。本研究旨在评估该方法相关的死亡率和各种并发症发生率。
对截至 2012 年 3 月发表的所有描述胸腹主动脉疾病联合开放血管内修复的文章进行电子健康数据库检索。如果研究纳入≥10 例患者且报告基本结局标准，则纳入荟萃分析。荟萃分析的终点定义为主要技术成功、内植物相关并发症、30 天/住院死亡率、脊髓缺血（SCI）和不可逆性截瘫症状、永久性肾功能损害和其他主要并发症。
共纳入 14 项研究，总计 528 例患者（68.0%为男性，平均年龄 70.5 岁），符合本荟萃分析的条件。平均随访时间为 34.2 个月。主要技术成功和内脏移植物通畅率的汇总估计值分别为 95.4%和 96.5%。106 例（21.1%）患者在完成两个阶段后出现内漏。有症状 SCI 的汇总发生率为 7.0%，不可逆性截瘫为 4.4%。永久性肾功能衰竭的汇总比例为 7.0%，肠系膜缺血为 4.5%。延长呼吸支持和心脏并发症的汇总发生率分别为 7.8%和 4.6%。30 天/住院死亡率的荟萃分析显示，汇总死亡率为 14.3%。
尽管杂交技术治疗胸腹主动脉病变提供了一种微创方法，但该技术仍然与相当高的发病率和死亡率相关。不适合接受开放修复的高危患者，同样可能因杂交手术而遭受严重并发症。应根据患者个体情况，仔细选择治疗胸腹主动脉病变的最佳治疗策略，评估每位患者的临床适宜性和解剖学适宜性。杂交方法应保留给具有丰富经验和高标准围手术期管理的大容量中心。
