Maskanakis Anastasios, Patelis Nikolaos, Moris Demetrios, Tsilimigras Diamantis I, Schizas Dimitrios, Diakomi Maria, Bakoyiannis Chris, Georgopoulos Sotirios, Klonaris Chris, Liakakos Theodoros
First Department of Surgery, Vascular Unit, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Ann Vasc Surg. 2018 Feb;47:291-304. doi: 10.1016/j.avsg.2017.08.013. Epub 2017 Sep 6.
Aneurysms of the subclavian artery are usually the result of trauma, atherosclerosis, or thoracic outlet syndrome. Until the 90s, open surgical repair was considered the only therapeutic choice, exhibiting high complication rates. Since the first report of endovascular repair of subclavian aneurysms in 1991, promising results have been published. The aim of this review was to summarize all available data on subclavian artery (SA) true and false aneurysm stenting to reach conclusions regarding morbidity, mortality, and other procedure-related characteristics.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Eligible studies were sought in the Medline (PubMed), ClinicalTrials.gov, and Cochrane library-Cochrane Central Register of Controlled Trials (CENTRAL) databases through February 2017 using the following MeSH terms: "endovascular", "hybrid", "aneurysm", "pseudo-aneurysm", "pseudo-aneurysm", "false aneurysm", "arterial injury", "subclavian artery", "axillo-subclavian," and "axillosubclavian artery". The reference lists of eligible articles and pertinent reviews were screened for potential relevant studies.
Seventy-three studies encompassing data on 142 patients who underwent endovascular or hybrid SA aneurysm repair were deemed eligible. One hundred forty-seven stents and stent grafts were used. Median age of all patients was 56 years, and males comprised 46% of the study sample. Trauma was the most common mechanism of injury. Pulsatile mass or hematoma was the most frequent presenting sign. Pseudoaneurysms were the most frequent type of aneurysms, followed by true aneurysms. Most authors used self-expanding polytetrafluoroethylene-covered stents. Access was obtained by either brachial, femoral, or both arteries. Through-and-through technique was also used in angulated vessels. All-cause mortality was 10.6%, slightly higher to that already reported in literature and lower to the respective rate of the open repair. Reintervention rate was 8.5% despite the high 15.5% complication rate.
Endovascular SA aneurysm repair is a technically feasible technique, useful in both elective and emergency cases. Although preliminary results quote its safety and efficacy, larger cohort studies are warranted to elucidate its benefit in treating SA aneurysms.
锁骨下动脉瘤通常由创伤、动脉粥样硬化或胸廓出口综合征引起。直到20世纪90年代，开放手术修复一直被认为是唯一的治疗选择，但并发症发生率很高。自1991年首次报道锁骨下动脉瘤的血管腔内修复以来，已有一些令人鼓舞的结果发表。本综述的目的是总结所有关于锁骨下动脉（SA）真性和假性动脉瘤支架置入的可用数据，以得出关于发病率、死亡率和其他与手术相关特征的结论。
根据系统评价和Meta分析的首选报告项目指南进行系统评价。通过2017年2月在Medline（PubMed）、ClinicalTrials.gov和Cochrane图书馆- Cochr ane对照试验中央注册库（CENTRAL）数据库中检索符合条件的研究，使用以下医学主题词：“血管腔内”、“杂交”、“动脉瘤”、“假性动脉瘤”、“动脉损伤”、“锁骨下动脉”、“腋-锁骨下”和“腋锁骨下动脉”。对符合条件的文章和相关综述的参考文献列表进行筛选，以寻找潜在的相关研究。
73项研究纳入了142例行血管腔内或杂交SA动脉瘤修复患者的数据，被认为符合条件。共使用了147个支架和支架移植物。所有患者的中位年龄为56岁，男性占研究样本的46%。创伤是最常见的损伤机制。搏动性肿块或血肿是最常见的临床表现。假性动脉瘤是最常见的动脉瘤类型，其次是真性动脉瘤。大多数作者使用自膨式聚四氟乙烯覆膜支架。通过肱动脉、股动脉或两者获取入路。对于成角血管也采用贯穿技术。全因死亡率为10.6%，略高于文献报道，低于开放修复的相应死亡率。尽管并发症发生率高达15.5%，再次干预率仍为8.5%。
血管腔内SA动脉瘤修复是一种技术上可行的技术，对择期和急诊病例均有用。尽管初步结果表明其安全性和有效性，但仍需要更大规模的队列研究来阐明其在治疗SA动脉瘤中的益处。
