Karaolanis Georgios, Antonopoulos Constantine N, Koutsias Stylianos, Antoniou George A, Beropoulis Efthymios, Torsello Giovanni, Taneva Gergana T, Donas Konstantinos P
Vascular Unit, Department of Surgery, University of Ioannina and School of Medicine, Ioannina, Greece.
Cardiothoracic and Vascular Surgery Department, General Hospital of Athens "Evangelismos," Athens, Greece.
Vascular. 2020 Oct;28(5):568-576. doi: 10.1177/1708538120923417. Epub 2020 May 9.
Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair.
The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals.
Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98-99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83-15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00-1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02-84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91-3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97-96.29) at a mean six months follow-up period.
Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.
在腹主动脉瘤的治疗中，血管内动脉瘤修复术已在手术领域中占据优势。然而，Ia型内漏是一种常见并发症，尤其是在使用腔内锚定器应对颈部解剖结构复杂的情况时。我们进行了一项系统评价和荟萃分析，以收集和分析关于标准血管内动脉瘤修复术中颈部解剖结构复杂或不复杂的患者行腔内缝合动脉瘤修复术结果的所有现有比较证据。
本次荟萃分析按照系统评价和荟萃分析的首选报告项目指南进行。所有报告首次使用Heli-FX腔内锚定器植入的前瞻性和回顾性研究均被认为符合纳入本研究的条件。主要研究结果（腔内锚定器植入的技术成功率、Ia型内漏的发生率、主动脉覆膜支架移位以及在整个随访过程中动脉瘤囊出现缩小或增大的患者百分比）随后以比例和95%置信区间表示。
八项研究共968例患者纳入汇总分析。初次腔内锚定器固定的技术成功率为97.12%（95%CI：92.98 - 99.67）。在平均六个月的随访期内，尽管进行了初次植入，仍有6.23%（95%CI：0.83 - 15.25）的患者发生持续性Ia型内漏。五项研究报告了主移植物的移位情况，其中0.26%（95%CI = 0.00 - 1.54）的患者需要额外的近端主动脉袖带。观察到动脉瘤囊缩小的比例为68.82%（95%CI：51.02 - 84.21）。1.93%（95%CI：0.91 - 3.24）的参与者出现动脉瘤囊增大。在平均六个月的随访期内，总生存率为93.43%（95%CI：89.97 - 96.29）。
使用Heli-FX腔内锚定器进行腔内缝合动脉瘤修复术在预防或修复术中Ia型内漏方面似乎在技术上是可行且安全的。尽管进行了腔内锚定器的初次植入，但仍有少数持续性Ia型内漏和移位病例较为明显。需要长期随访以确定这种治疗选择在主动脉瘤治疗中的作用。
