Li Yue, Hu Zhongzhou, Zhang Jinkang, Zheng Haibin, Wang Jianchang, Chen Zhong, Zhang Hongchao
Department of Cardiac Surgery, Air Force General Hospital of People's Liberation Army, Beijing, China.
Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Ann Vasc Surg. 2019 Apr;56:303-316. doi: 10.1016/j.avsg.2018.07.058. Epub 2018 Oct 2.
Iliac branch devices (IBDs) have been increasingly reported for treating aortoiliac aneurysms. However, there are still concerns regarding this device. The aim of this study was to evaluate the safety and outcomes of IBDs in treating aortoiliac aneurysms by performing a systematic review and meta-analysis.
The Medline, EMBASE, and Cochrane databases were systematically searched to identify studies on the management of aortoiliac aneurysms using IBDs. Studies were reviewed and selected using defined criteria by 2 independent investigators who abstracted data on the study characteristics, study quality, and outcomes. The extracted data were presented as a rate and converted through arcsine transformations. Individual studies were evaluated and analyzed for 7 outcomes, including technical success rate, 30-day mortality, 30-day patency, follow-up patency, endoleak rate, buttock claudication, and IBD-associated reintervention. The heterogeneity of the studies was determined using the chi-squared distribution-based Q test and quantified by I statistics. Meta-analyses were performed using both a random effects model and fixed effects model.
Twenty-two studies with a total of 1064 patients met the inclusion criteria and were selected for analysis. The pooled technical success rate of IBD was 93% (95% confidence interval [CI]: 91-95%). After patients were treated with the IBD, the 30-day mortality rate was 2% (95% CI, 1-4%), 30-day patency rate was 93% (95% CI, 91-94%), follow-up patency was 86% (95% CI, 84-88%), endoleak rate was 12% (95% CI, 8-17%), buttock claudication rate was 6% (95% CI, 5-8%), and IBD-associated reintervention rate was 11% (95% CI, 8-14%).
Our study demonstrates that treating aortoiliac aneurysm with IBD produces satisfactory outcomes in midterm follow-up.
髂支装置（IBD）治疗主髂动脉瘤的报道日益增多。然而，对该装置仍存在担忧。本研究的目的是通过进行系统评价和荟萃分析，评估IBD治疗主髂动脉瘤的安全性和疗效。
系统检索Medline、EMBASE和Cochrane数据库，以确定使用IBD治疗主髂动脉瘤的研究。由2名独立研究者根据既定标准对研究进行审查和选择，提取有关研究特征、研究质量和疗效的数据。提取的数据以率的形式呈现，并通过反正弦变换进行转换。对7项疗效指标进行个体研究评估和分析，包括技术成功率、30天死亡率、30天通畅率、随访通畅率、内漏率、臀部间歇性跛行和IBD相关再次干预。使用基于卡方分布的Q检验确定研究的异质性，并通过I统计量进行量化。采用随机效应模型和固定效应模型进行荟萃分析。
22项研究共1064例患者符合纳入标准并被选入分析。IBD的合并技术成功率为93%（95%置信区间[CI]：91-95%）。患者接受IBD治疗后，30天死亡率为2%（95%CI，1-4%），30天通畅率为93%（95%CI，91-94%），随访通畅率为86%（95%CI，84-88%），内漏率为12%（95%CI，8- 17%），臀部间歇性跛行率为6%（95%CI，5-8%），IBD相关再次干预率为11%（95%CI，8-14%）。
我们的研究表明，IBD治疗主髂动脉瘤在中期随访中产生了令人满意的疗效。
