Končar Igor B, Jovanović Aleksa L, Dučič Stefan M
Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia -
Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
J Cardiovasc Surg (Torino). 2020 Feb;61(1):24-36. doi: 10.23736/S0021-9509.19.11187-1.
Open repair (OR), fenestrated endovascular aneurysm repair (fEVAR) and endovascular exclusion using parallel graft (chEVAR) are complementary procedures used for treatment of juxtarenal abdominal aortic aneurysm (jrAAA). The aim of our study was to assess available literature and analyze dispersion of OR, fEVAR and chEVAR procedures among reported papers related to treatment of jrAAA.
The PubMed database was systematically searched using predefined strategy and key words related to treatment of jrAAA on September 28th, 2019. Studies were assessed for eligibility using the inclusion and exclusion criteria with at least five patients treated with at least one of the procedures while systematic reviews, meta-analysis, reviews, comments, editorials and letters were excluded as well as studies without clear classification of the location of the aneurysm, studies not specifying the number of patients treated with each of the techniques or not discriminated between aortic pathologies (juxtarenal, paravisceral and thoracoabdominal), hybrid procedures, endoanchors or with branched stent-graft.
Overall, 1533 papers were identified while papers that met inclusion criteria were either representing experience of single institution (87 papers) or from multicenter studies (6 papers), national or international registries (18 papers). In the period between January 1977 and December 2017, treatment of 5664 patients with jrAAA was reported in 87 papers as a single institution report. Out of them 2531 (45%) were treated with OR, 2592 (46%) with fEVAR and 541 (9%) with chEVAR. Out of 29 institutions reporting OR, there were 11 (37.9%) with more than 100 treated patients while 21 (41.1%) out of 51 institutions that reported more than 50 jrAAA treated with fEVAR. Only four institutions reported results of all three treatment modalities.
Based on the results reported in the literature, regardless of its complexity and costs, fEVAR for jrAAA has been accepted in substantial number of hospitals worldwide, while number of reported procedures is reaching OR.
开放修复术（OR）、开窗式血管内动脉瘤修复术（fEVAR）以及使用平行移植物的血管内隔绝术（chEVAR）是用于治疗近肾腹主动脉瘤（jrAAA）的互补性手术方法。我们研究的目的是评估现有文献，并分析OR、fEVAR和chEVAR手术在已发表的与jrAAA治疗相关论文中的分布情况。
于2019年9月28日使用预定义策略和与jrAAA治疗相关的关键词对PubMed数据库进行系统检索。根据纳入和排除标准评估研究的 eligibility，纳入标准为至少有五名患者接受了至少一种上述手术，同时排除系统评价、荟萃分析、综述、评论、社论和信函，以及未明确对动脉瘤位置进行分类的研究、未明确每种技术治疗患者数量的研究，或未区分主动脉病变类型（近肾型、肾旁型和胸腹型）的研究、杂交手术、腔内锚定器或分支型覆膜支架的研究。
总体而言，共识别出1533篇论文，符合纳入标准的论文要么代表单一机构的经验（87篇）要么来自多中心研究（6篇）、国家或国际注册研究（18篇）。在1977年1月至2017年12月期间，有87篇论文作为单一机构报告了5664例jrAAA患者的治疗情况。其中，2531例（45%）接受了OR治疗，2592例（46%）接受了fEVAR治疗，541例（9%）接受了chEVAR治疗。在报告OR的29个机构中，有11个（37.9%）治疗患者超过100例，而在报告超过50例jrAAA接受fEVAR治疗的51个机构中，有21个（41.1%）。只有四个机构报告了所有三种治疗方式的结果。
根据文献报道的结果，无论其复杂性和成本如何，jrAAA的fEVAR已在全球大量医院中被接受，而报告的手术数量正在接近OR。
