Lalys Florent, Daoudal Anne, Gindre Juliette, Göksu Cemil, Lucas Antoine, Kaladji Adrien
Therenva, Rennes, France.
INSERM U1099, Rennes, France; Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France; Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France.
J Vasc Surg. 2017 Jun;65(6):1830-1838. doi: 10.1016/j.jvs.2016.12.131. Epub 2017 Mar 27.
Sac shrinkage is considered a reliable surrogate marker of success after endovascular aneurysm repair (EVAR). Whereas sac shrinkage is the best expected outcome, predictive factors of sac shrinkage remain unclear. The aim of this study was to identify the role of preoperative and postoperative influencing factors of sac reduction after EVAR.
Online searches across MEDLINE, Embase, and Cochrane Library medical databases were simultaneously performed. Study effects were pooled using a random-effects model, and forest plots were generated for every potential influencing factor.
A total of 24 studies with 14,754 patients were included (mean age, 73.4 years; 76% male). At a mean follow-up of 24 months, the pooled shrinkage proportion was 47%. Random-effects meta-analysis revealed that renal impairment (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.57-0.96), type I endoleaks (OR, 0.17; 95% CI, 0.08-0.39), type II endoleaks (OR, 0.21; 95% CI, 0.14-0.33), and combined type I and type II endoleaks (OR, 0.32; 95% CI, 0.22-0.47) were found to prevent sac shrinkage, whereas hypercholesterolemia (OR, 1.24; 95% CI, 1.02-1.51) and smoking (OR, 1.32; 95% CI, 1.17-1.49) have a significant positive impact on sac shrinkage. In addition, there was a trend toward the association between shrinkage and statin therapy (OR, 4.07; 95% CI, 1.02-16.32) and nearly significant negative impacts of coronary artery disease (OR, 0.84; 95% CI, 0.70-1.01), diabetes (OR, 0.79; 95% CI, 0.60-1.04), and sac thrombus (OR, 0.88; 95% CI, 0.77-1.01) on sac shrinkage.
In this large meta-analysis of patients undergoing EVAR, we found that several comorbidity and postoperative factors were associated with postoperative sac shrinkage. These findings may contribute to a better understanding of the shrinkage process of patients undergoing EVAR.
在血管内动脉瘤修复术（EVAR）后，瘤囊缩小被认为是成功的可靠替代指标。尽管瘤囊缩小是最佳预期结果，但瘤囊缩小的预测因素仍不明确。本研究的目的是确定EVAR术后瘤囊缩小的术前和术后影响因素的作用。
同时在MEDLINE、Embase和Cochrane图书馆医学数据库中进行在线检索。使用随机效应模型汇总研究效应，并为每个潜在影响因素生成森林图。
共纳入24项研究，涉及14754例患者（平均年龄73.4岁；76%为男性）。平均随访24个月时，汇总的缩小比例为47%。随机效应荟萃分析显示，肾功能损害（比值比[OR]，0.74；95%置信区间[CI]，0.57 - 0.96）、I型内漏（OR，0.17；95% CI，0.08 - 0.39）、II型内漏（OR，0.21；95% CI，0.14 - 0.33）以及I型和II型内漏合并（OR，0.32；95% CI，0.22 - 0.47）可阻止瘤囊缩小，而高胆固醇血症（OR，1.24；95% CI，1.02 - 1.51）和吸烟（OR，1.32；95% CI，1.17 - 1.49）对瘤囊缩小有显著的正向影响。此外，瘤囊缩小与他汀类药物治疗之间存在关联趋势（OR，4.07；95% CI，1.02 - 16.32），冠状动脉疾病（OR，0.84；95% CI，0.70 - 1.01）、糖尿病（OR，0.79；95% CI，0.60 - 1.04）和瘤囊血栓（OR，0.88；95% CI，0.77 - 1.01）对瘤囊缩小有近乎显著的负面影响。
在这项对接受EVAR的患者进行的大型荟萃分析中，我们发现几种合并症和术后因素与术后瘤囊缩小有关。这些发现可能有助于更好地理解接受EVAR的患者的瘤囊缩小过程。
