Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
J Vasc Surg. 2022 Feb;75(2):740-752.e1. doi: 10.1016/j.jvs.2021.09.031. Epub 2021 Oct 8.
We have summarized the available in situ laser fenestration (ISLF) literature, including experimental studies with their subsequent recommendations regarding the optimal fenestration technique and fabric, and the short- and mid-term results of clinical studies.
A systematic search for English-language reports was performed in MEDLINE, the Cochrane Database, and EMBASE in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines by two investigators (C.F.P. and D.L.). The search period was from inception of the databases to August 31, 2020. The search terms included in situ, laser, fenestration, and endograft. A quality assessment of the studies was performed using the Newcastle-Ottawa scale by two other investigators (G.T. and A.W.) independently.
A total of 19 clinical studies were included, with a total of 428 patients (390 cases of supra-aortic trunk ISLF, 38 cases of visceral vessel ISLF). The technical success rate was 96.9% and 95.6% for supra-aortic and visceral vessel ISLF, respectively. Most studies had reported <12 months of follow-up. The longest available follow-up was in one study at 5 years for left subclavian artery ISLF and 17 months for visceral vessel ISLF. Overall, the quality of the evaluated clinical studies was low. Six experimental studies were included, with the highest level of evidence suggesting fenestration of multifilament polyethylene terephthalate grafts, followed by dilation with either a 6- or 8-mm noncompliant balloon.
The results from experimental studies favor the use of multifilament polyethylene terephthalate, followed by dilation with noncompliant balloons as the most durable in vitro technique for ISLF. The short-term outcomes for arch and visceral vessel revascularization have been promising, with low rates of in-hospital mortality, stroke, and end-organ ischemia. Nonetheless, the long-term durability of ISLF has not yet been determined, and ISLF should be limited to selected symptomatic and urgent cases.
我们总结了现有的腔内激光开窗术（ISLF）文献，包括实验研究及其随后关于最佳开窗技术和材料的建议，以及临床研究的短期和中期结果。
两名研究人员（C.F.P. 和 D.L.）按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南，在 MEDLINE、Cochrane 数据库和 EMBASE 中进行了英语文献的系统搜索。搜索时间从数据库建立到 2020 年 8 月 31 日。搜索词包括原位、激光、开窗和移植物。另外两名研究人员（G.T. 和 A.W.）独立使用纽卡斯尔-渥太华量表对研究进行了质量评估。
共纳入 19 项临床研究，共 428 例患者（390 例主动脉弓部 ISLF，38 例内脏血管 ISLF）。主动脉弓部和内脏血管 ISLF 的技术成功率分别为 96.9%和 95.6%。大多数研究报告的随访时间<12 个月。最长的随访时间是一项左锁骨下动脉 ISLF 研究的 5 年和内脏血管 ISLF 的 17 个月。总体而言，评估的临床研究质量较低。纳入了 6 项实验研究，其中证据水平最高的是多丝聚对苯二甲酸乙二醇酯移植物开窗，其次是使用 6 或 8mm 顺应性球囊扩张。
实验研究结果表明，多丝聚对苯二甲酸乙二醇酯开窗，然后使用顺应性球囊扩张是 ISLF 最耐用的体外技术。升主动脉和内脏血管血运重建的短期结果令人鼓舞，院内死亡率、中风和终末器官缺血发生率较低。然而，ISLF 的长期耐久性尚未确定，ISLF 应仅限于有症状和紧急情况的患者。
