Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Eur J Vasc Endovasc Surg. 2018 Nov;56(5):644-651. doi: 10.1016/j.ejvs.2018.07.018. Epub 2018 Aug 16.
OBJECTIVE/BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is an emerging therapy for thoracic aortic pathologies. However, the role of left subclavian artery (LSA) revascularisation in patients with LSA coverage in TEVAR has not been established. A systematic review and meta-analysis was done to investigate the effect of LSA revascularisation in TEVAR when the LSA was covered.
PubMed, Embase, and the Cochrane Library were searched to find relevant randomised controlled trials (RCTs) and cohort studies. The Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale was used to evaluate the methodological quality of RCTs and cohort studies respectively. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to express differences for dichotomous outcomes. Random effects models were used to combine outcomes for studies with I > 50%; otherwise, fixed effects models were used. Subgroup analyses and sensitivity analyses were performed to further validate the results.
Sixteen cohort studies with a total of 2591 patients were included in this systematic review and meta-analysis. The average score of the included studies was 7.56. Of the included patients, the peri-operative stroke rate was 6.8% (n = 176/2591). The peri-operative stroke rates of the with and without LSA revascularisation groups were 5.4% and 7.8%, respectively. Compared with no LSA revascularisation, patients with LSA revascularisation had a significantly lower peri-operative stroke rate (RR 0.61; 95% CI 0.45-0.82; I = 20%) and peri-operative spinal cord ischaemia (SCI) rate (RR 0.59; 95% CI 0.39-0.90; I = 0). No significant difference was found between the with and without LSA revascularisation groups with respect to peri-operative mortality (RR 0.86; 95% CI 0.60-1.21; I = 35%) and peri-operative paraplegia (RR 0.81; 95% CI 0.45-1.44; I = 17%).
The results of this review reveal that LSA revascularisation was associated with significantly lower peri-operative stroke and SCI rates. LSA revascularisation should be recommended for patients with LSA coverage in TEVAR. High quality RCTs are needed to further validate the conclusion.
目的/背景：胸主动脉腔内修复术（TEVAR）是一种新兴的治疗胸主动脉疾病的方法。然而，在 TEVAR 中覆盖左锁骨下动脉（LSA）时，左锁骨下动脉（LSA）血运重建的作用尚未确定。进行了系统评价和荟萃分析，以研究 LSA 覆盖时 TEVAR 中 LSA 血运重建的效果。
检索 PubMed、Embase 和 Cochrane 图书馆，以查找相关的随机对照试验（RCT）和队列研究。使用 Cochrane 偏倚风险工具和纽卡斯尔-渥太华量表分别评估 RCT 和队列研究的方法学质量。使用相对风险（RR）和 95%置信区间（CI）表示二分类结局的差异。对于 I ²>50%的研究，使用随机效应模型进行合并；否则，使用固定效应模型。进行亚组分析和敏感性分析以进一步验证结果。
本系统评价和荟萃分析共纳入 16 项队列研究，共 2591 例患者。纳入研究的平均评分为 7.56 分。在纳入的患者中，围手术期卒中发生率为 6.8%（n=176/2591）。有和无 LSA 血运重建组的围手术期卒中发生率分别为 5.4%和 7.8%。与无 LSA 血运重建相比，LSA 血运重建患者的围手术期卒中发生率显著降低（RR 0.61；95%CI 0.45-0.82；I²=20%）和围手术期脊髓缺血（SCI）发生率（RR 0.59；95%CI 0.39-0.90；I²=0）。有和无 LSA 血运重建组之间，围手术期死亡率（RR 0.86；95%CI 0.60-1.21；I²=35%）和围手术期截瘫（RR 0.81；95%CI 0.45-1.44；I²=17%）无显著差异。
本综述结果表明，LSA 血运重建与显著较低的围手术期卒中发生率和 SCI 发生率相关。在 TEVAR 中覆盖 LSA 时，应建议进行 LSA 血运重建。需要高质量的 RCT 进一步验证这一结论。
