Abraha Iosief, Romagnoli Carlo, Montedori Alessandro, Cirocchi Roberto
Epidemiology Department, Regional Health Authority of Umbria, Via Mario Angeloni, 61, Perugia, Italy, 06124.
Cochrane Database Syst Rev. 2013 Sep 11(9):CD006796. doi: 10.1002/14651858.CD006796.pub3.
Thoracic aortic aneurysm (TAA) is an uncommon disease with an incidence of 10.4 per 100,000 inhabitants. It occurs mainly in older individuals and is evenly distributed among both sexes. There are no signs or symptoms indicative of the presence of the disease. Progressive but unpredictable enlargement of the dilated aorta is the natural course of the disease and can lead to rupture. Open chest surgical repair using prosthetic graft interposition has been a conventional treatment for TAAs. Despite improvements in surgical procedures perioperative complications remain significant. The alternative option of thoracic endovascular aneurysm repair (TEVAR) is considered a less invasive and potentially safer technique, with lower morbidity and mortality compared with conventional treatment. Evidence is needed to support the use of TEVAR for these patients, rather than open surgery.
The aim of this review is to assess the efficacy of TEVAR versus conventional open surgery in patients with TAAs.
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2013) and CENTRAL (2013, Issue 2).
Randomised controlled trials in which patients with TAAs were randomly assigned to TEVAR or open surgical repair.
Two review authors independently identified and evaluated potential trials for eligibility. Excluded studies were further checked by another author. We did not perform any statistical analyses as no randomised controlled trials were identified.
We did not find any published or unpublished randomised controlled trials comparing TEVAR with conventional open surgical repair for the treatment of thoracic aortic aneurysms.
AUTHORS' CONCLUSIONS: Though stent grafting of the thoracic aorta is technically feasible and non-randomised studies suggest reduction of early outcomes such as paraplegia, mortality and hospital stay, high quality randomised controlled trials assessing all clinically relevant outcomes including open-conversion, aneurysm exclusion, endoleaks, and late mortality are needed.
胸主动脉瘤（TAA）是一种罕见疾病，发病率为每10万居民中有10.4例。它主要发生在老年人中，且在男女中分布均匀。没有迹象或症状表明该疾病的存在。扩张主动脉的渐进性但不可预测的扩大是该疾病的自然病程，可导致破裂。使用人工血管置换进行开胸手术修复一直是治疗胸主动脉瘤的传统方法。尽管手术程序有所改进，但围手术期并发症仍然很严重。胸主动脉腔内修复术（TEVAR）这一替代选择被认为是一种侵入性较小且可能更安全的技术，与传统治疗相比，发病率和死亡率更低。需要证据来支持对这些患者使用TEVAR而非开放手术。
本综述的目的是评估TEVAR与传统开放手术治疗胸主动脉瘤患者的疗效。
为了本次更新，Cochrane外周血管疾病组试验搜索协调员检索了专业注册库（最后检索时间为2013年3月）和Cochrane系统评价数据库（2013年第2期）。
将胸主动脉瘤患者随机分配至TEVAR或开放手术修复的随机对照试验。
两位综述作者独立识别并评估潜在试验的纳入资格。被排除的研究由另一位作者进一步检查。由于未识别到随机对照试验，我们未进行任何统计分析。
我们未找到任何已发表或未发表的比较TEVAR与传统开放手术修复治疗胸主动脉瘤的随机对照试验。
尽管胸主动脉支架植入术在技术上是可行的，且非随机研究表明可降低诸如截瘫、死亡率和住院时间等早期结局，但仍需要高质量的随机对照试验来评估所有临床相关结局，包括开放转换、动脉瘤隔绝、内漏和晚期死亡率。
