SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Surgery, National University Hospital, Singapore.
SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Vasc Surg. 2019 Nov;70(5):1682-1693.e1. doi: 10.1016/j.jvs.2019.02.040.
After the use of thoracic endovascular aortic repair in the management of type B aortic dissection (TBAD), there has been increasing recognition of the phenomenon of stent graft-induced new entry (SINE) as a late complication of thoracic endovascular aortic repair, with risk factors for SINE identified. We performed a meta-analysis of contemporary studies to establish the risk factors for distal SINE (dSINE).
A systematic search of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to investigate the risk factors for dSINE. Data from population-cohort and case-control studies were extracted to compute a conventional meta-analysis by combining the odds ratio using the generic inverse variance function on RevMan 5.3. Furthermore, a meta-analysis of proportions using the Freeman-Tukey double arcsine transformation was performed to compare the incidence of acute and chronic TBAD.
Seventeen studies assessing the data of 3962 patients met the eligibility requirements and were included in the review. The pooled proportion of dSINE in TBAD cases treated with thoracic endovascular aortic repair is 10.1%. The relative risk of incidence of dSINE in chronic TBAD compared to acute TBAD is 3.12. The chronicity of TBAD and excessive distal oversizing ratio was demonstrated to be positively associated with dSINE with odds ratios of 2.25 and 2.06, respectively. Stent grafts with connecting bars were also positively associated with dSINE, but this lacked statistical significance.
This meta-analysis demonstrated that chronic TBAD and an excessive distal oversizing ratio are both positively and independently associated with the incidence of dSINE tears in TBAD. This should be taken into consideration when planning interventions in these patient cohorts.
在使用胸主动脉腔内修复术（TEVAR）治疗 B 型主动脉夹层（TBAD）后，支架移植物诱导的新入口（SINE）作为 TEVAR 的晚期并发症越来越受到关注，并且已经确定了 SINE 的危险因素。我们对当代研究进行了荟萃分析，以确定远端 SINE（dSINE）的危险因素。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对文献进行了系统检索，以研究 dSINE 的危险因素。从人群队列和病例对照研究中提取数据，使用 RevMan 5.3 中的通用倒数方差函数计算常规荟萃分析，计算比值比。此外，还使用 Freeman-Tukey 双反正弦变换进行了荟萃分析比例比较急性和慢性 TBAD 的发生率。
评估了 3962 例患者数据的 17 项研究符合纳入标准，并纳入了综述。在接受 TEVAR 治疗的 TBAD 患者中，dSINE 的总体发生率为 10.1%。与急性 TBAD 相比，慢性 TBAD 发生 dSINE 的相对风险为 3.12。TBAD 的慢性和过度远端过度扩张比与 dSINE 的发生呈正相关，优势比分别为 2.25 和 2.06。带连接条的支架移植物也与 dSINE 呈正相关，但无统计学意义。
这项荟萃分析表明，慢性 TBAD 和过度远端过度扩张比均与 TBAD 中 dSINE 撕裂的发生率呈正相关且独立相关。在这些患者队列中计划干预措施时应考虑到这一点。
