编辑精选 - 血管内主动脉瘤修复中使用 Endoanchors 的系统评价。
Editor's Choice - Systematic Review of the Use of Endoanchors in Endovascular Aortic Aneurysm Repair.
机构信息
Department of Vascular and Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Vascular and Interventional Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Alfa Institute of Biomedical Sciences, Marousi, Greece.
出版信息
Eur J Vasc Endovasc Surg. 2020 May;59(5):748-756. doi: 10.1016/j.ejvs.2020.02.008. Epub 2020 Mar 17.
OBJECTIVE
Endoanchor fixation might be a potential adjunct for the prevention and treatment of type Ia endoleak (TIaE) and graft migration in thoracic or abdominal endovascular aortic aneurysm repairs (TEVAR or EVAR). This review aimed to explore the safety and effectiveness of endoanchor fixation in TEVAR and EVAR.
METHODS
A systematic review and random effects meta-analysis was conducted. Data sources were PubMed/MEDLINE, Embase, and the Cochrane Library.
RESULTS
Seven EVAR and three TEVAR studies using the Heli-FX™ EndoAnchor™ system were included in the meta-analysis. A total of 455 EVAR patients underwent primary endoanchor fixation. Technical success was 98.4% (95% CI 95.7-99.8%). The rate of TIaE and graft migration was 3.5% (95% CI 1.7-5.9%) and 2.0% (95% CI 0.12-6.0%), respectively, after 15.4 months (95% CI 1.76-29.0) follow up. A total of 107 EVAR patients underwent secondary fixation with a technical success of 91.8% (95% CI 86.1-96.2%). Rates of TIaE and graft migration were 22.6% (95% CI 9.1-40.0%) and 0% after a mean 10.7 month (95% CI 7.8-13.6) follow up. Adverse events included three endoanchor fractures, three dislocated endoanchors, one entrapped endoanchor, and one common iliac artery dissection. All cause 30 day EVAR mortality was 0.82% (95% CI 0.20-1.85%). Sixty-six TEVAR patients underwent endoanchor fixation with a mean 9.8 month (95% CI 8.1-11.5) follow up. Technical success was 90.3% (95% CI 72.1-99.4%). The rates of TIaE and migration were 8.7% (95% CI 1.0-18.9%) and 0%, respectively. Adverse events included two misdeployed endoanchors with one fatal aortic dissection. All cause 30 day TEVAR mortality was 11.9% (95% CI 5.4-20.6%).
CONCLUSION
Endoanchor fixation in EVAR is technically feasible and safe, with at least comparable early outcomes to the latest generation of stent grafts. Endostapling in TEVAR is associated with lower technical success, higher peri-operative mortality, and potential serious adverse events. Current evidence lacks long term follow up and case controlled trials to recommend endoanchor use in routine practice.
目的
Endoanchor 固定术可能是预防和治疗胸主动脉或腹主动脉血管内修复术（TEVAR 或 EVAR）中Ⅰa 型内漏（TIaE）和移植物迁移的潜在辅助手段。本综述旨在探讨 Endoanchor 固定术在 TEVAR 和 EVAR 中的安全性和有效性。
方法
进行了系统评价和随机效应荟萃分析。数据来源为 PubMed/MEDLINE、Embase 和 Cochrane 图书馆。
结果
共有 7 项 EVAR 和 3 项 TEVAR 研究使用了 Heli-FX™ EndoAnchor™系统，纳入荟萃分析。共有 455 例 EVAR 患者接受了初次 Endoanchor 固定术。技术成功率为 98.4%（95%CI 95.7-99.8%）。在 15.4 个月（95%CI 1.76-29.0）的随访中，TIaE 和移植物迁移的发生率分别为 3.5%（95%CI 1.7-5.9%）和 2.0%（95%CI 0.12-6.0%）。在 107 例 EVAR 患者中进行了二次固定，技术成功率为 91.8%（95%CI 86.1-96.2%）。在平均 10.7 个月（95%CI 7.8-13.6）的随访中，TIaE 和移植物迁移的发生率分别为 22.6%（95%CI 9.1-40.0%）和 0%。不良事件包括 3 例 Endoanchor 骨折、3 例移位的 Endoanchor、1 例夹闭的 Endoanchor 和 1 例髂总动脉夹层。所有原因的 30 天 EVAR 死亡率为 0.82%（95%CI 0.20-1.85%）。66 例 TEVAR 患者接受了 Endoanchor 固定术，平均随访时间为 9.8 个月（95%CI 8.1-11.5）。技术成功率为 90.3%（95%CI 72.1-99.4%）。TIaE 和迁移的发生率分别为 8.7%（95%CI 1.0-18.9%）和 0%。不良事件包括 2 例锚定器放置不当，其中 1 例发生致命性主动脉夹层。所有原因的 30 天 TEVAR 死亡率为 11.9%（95%CI 5.4-20.6%）。
结论
EVAR 中的 Endoanchor 固定术在技术上是可行和安全的，至少与最新一代支架移植物具有相当的早期结果。TEVAR 中的 Endostapling 与较低的技术成功率、较高的围手术期死亡率和潜在的严重不良事件相关。目前的证据缺乏长期随访和病例对照试验来推荐在常规实践中使用 Endoanchor。
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