Department of Diagnostic Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
University of Arkansas School of Medicine, 4301 W Markham, Little Rock, AR, 72205, USA.
Cardiovasc Intervent Radiol. 2020 May;43(5):706-713. doi: 10.1007/s00270-020-02425-5. Epub 2020 Feb 26.
To evaluate the comparative outcome and cost of vascular plugs versus coils for internal iliac artery embolization prior to endovascular aortic aneurysm repair.
A search was performed for internal iliac artery embolization studies in adult patients from January 2005 to July 2018. Inclusion criteria included embolization of unilateral or bilateral IIAs with either coils or plug(s) prior to endovascular aortic repair. Meta-analysis was performed using a fixed effects model with the inverse variance-weighted average method to determine pooled differences in surgical time, fluoroscopy time, radiation exposure, number of devices used, cost of devices, and post-embolization buttock claudication. Heterogeneity was assessed using the Chi-square statistic. Pooled outcomes were compared, and quality assessments were evaluated using the Newcastle-Ottawa scale.
Six studies met inclusion criteria. One hundred and eighty-one patients were included in the study, of which 87 were in the plug group and 94 in the coil group. Vascular plug use led to 35.32 min shorter surgery time (p < 0.001), 15.64 min less fluoroscopy time (p < 0.001), 157,599 mGy/cm less radiation (p < 0.001), and 5.88 fewer occlusive devices (p < 0.001) than the use of coils alone. The estimated total cost of occlusion devices was $575.45 USD lower in the plug cohort (p < 0.001). The development of buttock claudication 12 months after EVAR was 11% less likely in the plug cohort but was not statistically significant (p = 0.71).
The vascular plug appears to be superior to coils in embolization of the internal iliac artery due to shorter surgical time, fluoroscopy time, radiation exposure, and total cost of occlusive devices.
评估血管塞与线圈用于血管内腹主动脉瘤修复前髂内动脉栓塞的比较结果和成本。
从 2005 年 1 月至 2018 年 7 月，对成人患者的髂内动脉栓塞研究进行了检索。纳入标准包括在血管内主动脉修复前使用线圈或塞子栓塞单侧或双侧 IIA。使用固定效应模型和倒数方差加权平均法进行荟萃分析，以确定手术时间、透视时间、辐射暴露、使用设备数量、设备成本和栓塞后臀部跛行的 pooled 差异。使用卡方检验评估异质性。比较汇总结果，并使用纽卡斯尔-渥太华量表进行质量评估。
符合纳入标准的有 6 项研究。研究共纳入 181 例患者，其中 87 例为塞子组，94 例为线圈组。血管塞的使用使手术时间缩短 35.32 分钟（p<0.001），透视时间减少 15.64 分钟（p<0.001），辐射量减少 157599mGy/cm（p<0.001），闭塞装置减少 5.88 个（p<0.001）。与单独使用线圈相比，塞子组闭塞装置的总费用估计降低了 575.45 美元（p<0.001）。EVAR 后 12 个月，塞子组臀部跛行的发生率降低了 11%，但无统计学意义（p=0.71）。
血管塞在髂内动脉栓塞中优于线圈，因为它可以缩短手术时间、透视时间、辐射暴露和闭塞装置的总成本。
