Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2020 Jun 30;35(2):135-141. doi: 10.24920/003618.
Objective Type Ⅱ endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair (EVAR). The efficacy of transarterial (TA) embolization and translumber (TL) embolization in the management of type Ⅱ endoleak remains equipoise. The aim of this study is to compare the technical and clinical success between TA embolization and TL embolization for type Ⅱ endoleak after EVAR.Methods The protocol was registered (CRD 42018114453) and the electronic databases (Pubmed, Embase, Web of Science, and Cochrane) were systematically searched till March 2019. The search terms included EVAR, type Ⅱ endoleak, and embolization. The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type Ⅱ endoleak after EVAR. The technical and clinical success rates were meta-analyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type Ⅱ endoleaks were included. The pooled odds ratio () of technical success rate for TA . TL was 0.56 (95% , 0.10-3.18; =0.51) and the pooled of clinical success rate for TA TL was 0.31(95% , 0.07-1.29; =0.11). As a limitation, 6 articles were all retrospective studies which may lead to bias.Conclusion Both TA and TL could be effective procedure of embolizations to resolve the type Ⅱ endoleak. The meta-analysis result indicated that TA embolization was not inferior to TL embolization in technical success and clinical success.
目的 Ⅱ 型内漏是血管内动脉瘤修复(EVAR)后最常见的内漏并发症。经动脉(TA)栓塞和经腔(TL)栓塞治疗 Ⅱ 型内漏的疗效仍存在争议。本研究旨在比较 EVAR 后 Ⅱ 型内漏患者 TA 栓塞与 TL 栓塞的技术和临床成功率。
方法 本研究方案已在临床试验注册平台(CRD42018114453)注册,并对 Pubmed、Embase、Web of Science 和 Cochrane 等电子数据库进行了系统检索,检索时间截至 2019 年 3 月。检索词包括 EVAR、Ⅱ 型内漏和栓塞。由两名作者独立阅读和提取文章,纳入比较 EVAR 后发生 Ⅱ 型内漏患者行 TA 栓塞与 TL 栓塞的随机对照试验和回顾性研究。采用随机效应模型对技术和临床成功率进行荟萃分析。
结果 共纳入 6 篇文章,共计 268 例患者和 290 例 Ⅱ 型内漏。TA 栓塞的技术成功率的汇总比值比(OR)为 0.56(95%CI,0.10-3.18;=0.51),TL 栓塞的临床成功率的汇总 OR 为 0.31(95%CI,0.07-1.29;=0.11)。局限性在于,6 篇文章均为回顾性研究,可能存在偏倚。
结论 TA 和 TL 均可作为解决 Ⅱ 型内漏的有效栓塞方法。Meta 分析结果表明,TA 栓塞在技术成功率和临床成功率方面并不逊于 TL 栓塞。