Spanos Konstantinos, Antoniou George Α, Giannoukas Athanasios D, Rohlffs Fiona, Tsilimparis Nikolaos, Debus Sebastian E, Kölbel Tilo
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany -
Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
J Cardiovasc Surg (Torino). 2018 Apr;59(2):213-224. doi: 10.23736/S0021-9509.18.10341-7. Epub 2018 Jan 9.
The aim of this study was to evaluate the long term durability of fenestrated endovascular aortic aneurysm repair (F-EVAR) of juxta-renal aortic aneurysms (JAAAs) in terms of mortality, target visceral vessel (TVV) patency and Reintervention rates.
A systematic review and meta-analysis was performed. MEDLINE, CENTRAL, and Cochrane databases were searched with PRISMA methodology for studies reporting on F-EVAR of JAAA presenting follow-up >36 months. Articles with <15 patients, follow-up <36 months, comparison of F-EVAR with other treatment modalities were excluded.
Seven non-randomized retrospective studies of prospectively collected data were analysed including 772 patients (mean age and diameter ranging from 71.5 to 74 years and from 60 to 65mm, respectively) underwent F-EVAR for JAAA during 2001-2015. The pooled mortality rates during 12, 24, 36, 48 and 60 months were 0.080 (0.060-0.106), 0.129 (0.097-0.169), 0.211 (0.158-0.277), 0.279 (0.193-0.386) and 0.405 (0.303-0.517), respectively. The pooled Reintervention rates during 12, 24, 36 and 48 months were 0.097 (0.066-0.140), 0.131 (0.082-0.203), 0.281 (0.182-0.406) and 0.244 (0.103-0.477), respectively. The pooled loss of TVV patency rates during 12, 24, 36, 48 and 60 months were 0.046 (0.035-0.060), 0.081 (0.058-0.110), 0.088 (0.060-0.127), 0.123 (0.067-0.214) and 0.132 (0.081-0.207).
F-EVAR for the treatment of patients with JAAA is a durable procedure with good long term outcomes in terms of mortality and visceral vessels patency. During long term period the need for a Reintervention continues to exists, thus follow-up of those cases may be important for preserving the good results.
本研究旨在从死亡率、目标内脏血管（TVV）通畅率和再次干预率方面评估开窗式血管内主动脉瘤修复术（F-EVAR）治疗近肾主动脉瘤（JAAAs）的长期耐久性。
进行了一项系统评价和荟萃分析。采用PRISMA方法检索MEDLINE、CENTRAL和Cochrane数据库，以查找报告JAAA的F-EVAR且随访时间>36个月的研究。排除患者<15例、随访时间<36个月、F-EVAR与其他治疗方式比较的文章。
分析了7项对前瞻性收集数据的非随机回顾性研究，包括772例患者（平均年龄和直径分别为71.5至74岁和60至65mm），这些患者在2001年至2015年期间接受了JAAA的F-EVAR治疗。12、24、36、48和60个月时的汇总死亡率分别为0.080（0.060 - 0.106）、0.129（0.097 - 0.169）、0.211（0.158 - 0.277）、0.279（0.193 - 0.386）和0.405（0.303 - 0.517）。12、24、36和48个月时的汇总再次干预率分别为0.097（0.066 - 0.140）、0.131（0.082 - 0.203）、0.281（0.182 - 0.406）和0.244（0.103 - 0.477）。12、24、36、48和60个月时TVV通畅丧失的汇总率分别为0.046（0.035 - 0.060）、0.081（0.058 - 0.110）、0.088（0.060 - 0.127）、0.123（0.067 - 0.214）和0.132（0.081 - 0.207）。
F-EVAR治疗JAAA患者是一种持久的手术方法，在死亡率和内脏血管通畅方面具有良好的长期效果。在长期随访期间，再次干预的需求仍然存在，因此对这些病例的随访对于保持良好结果可能很重要。
