Han Maonan, Wang Jiarong, Zhao Jichun, Ma Yukui, Huang Bin, Yuan Ding, Yang Yi
Department of Vascular Surgery, West China Hospital, Chengdu, China.; West China School of Medicine, Sichuan University, Chengdu, China.
Department of Vascular Surgery, West China Hospital, Chengdu, China.
Ann Vasc Surg. 2022 Feb;79:348-358. doi: 10.1016/j.avsg.2021.07.025. Epub 2021 Oct 10.
The aim of our systematic review and meta-analysis was to demonstrate the clinical outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infective native aortic aneurysms (INAAs).
MEDLINE, Embase, and Cochrane Databases were searched for articles reporting OSR and/or EVAR repair of INAA. The methodological quality of included studies was assessed by the Newcastle-Ottawa scale and Moga-Score. Random-effects models were used to calculate the pooled measures.
A total of 34 studies were included, with 22 studies reporting OSR alone, 6 studies reporting EVAR alone and 6 comparative studies for INAAs. The pooled estimates of infection-related complications (IRCs) were 8.2% (95% CI 4.9%-12.2%) in OSR cohort and 23.2% (95% CI 16.1%-31.0%) in EVAR cohort. EVAR was associated with a significantly increased risk of IRCs compared with OSR during follow-up (OR 1.9, 95% CI 1.0-3.7). As for survival outcomes, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality in OSR cohort were 11.7% (95% CI 7.7%-16.1%), 21.6% (95%CI 16.3%-27.4%) and 28.3% (95% CI 20.5%-36.7%; I=50.47%), respectively. For EVAR cohort, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality were 4.9% (95% CI 1.1%-10.4%), 9.4% (95% CI 2.7%-18.7%) and 22.2% (95% CI 12.4%-33.7%), respectively. EVAR was associated with a significantly decreased of 30-day mortality (OR 0.2, 95% CI 0.1-0.6). However, no difference was found between EVAR and OSR in 3-month (OR 0.2, 95% CI 0-1.1), 1-year all-cause mortality (OR 0.4, 95% CI 0.1-1.1) or aneurysm-related mortality (OR 1.4, 95% CI 0.5-3.9). Moreover, no difference of incidence of reintervention was observed (OR 2.6, 95% CI 0.9-7.7; I=53.7%) between two groups.
EVAR could provide better short-term survival than OSR in patients with INAAs. However, patients undergoing EVAR suffered from higher risks of IRCs. EVAR could be considered as an alternative for low-risk patients with well-controlled infections or patients considered high-risk for open reconstruction.
我们进行系统评价和荟萃分析的目的是阐明开放性手术修复（OSR）和血管腔内动脉瘤修复（EVAR）治疗感染性原发性主动脉瘤（INAA）的临床结局。
检索MEDLINE、Embase和Cochrane数据库，查找报告INAA的OSR和/或EVAR修复的文章。纳入研究的方法学质量通过纽卡斯尔-渥太华量表和Moga评分进行评估。采用随机效应模型计算合并指标。
共纳入34项研究，其中22项研究仅报告了OSR，6项研究仅报告了EVAR，6项为INAA的比较研究。OSR队列中感染相关并发症（IRC）的合并估计值为8.2%（95%CI 4.9%-12.2%），EVAR队列中为23.2%（95%CI 16.1%-31.0%）。与OSR相比，EVAR在随访期间发生IRC的风险显著增加（OR 1.9，95%CI 1.0-3.7）。至于生存结局，OSR队列中全因30天、3个月和1年死亡率的汇总估计率分别为11.7%（95%CI 7.7%-16.1%）、21.6%（95%CI 16.3%-27.4%）和28.3%（95%CI 20.5%-3I 6.7%；I=50.47%）。对于EVAR队列，全因30天、3个月和1年死亡率的汇总估计率分别为4.9%（95%CI 1.1%-10.4%）、9.4%（95%CI 2.7%-18.7%）和22.2%（95%CI 12.4%-33.7%）。EVAR与30天死亡率显著降低相关（OR 0.2，95%CI 0.1-0.6）。然而，在3个月（OR 0.2，95%CI 0-1.1）、1年全因死亡率（OR 0.4，95%CI 0.1-1.1）或动脉瘤相关死亡率（OR 1.4，95%CI 0.5-3.9）方面，EVAR和OSR之间未发现差异。此外，两组之间再干预发生率无差异（OR 2.6，95%CI 0.9-7.7；I=53.7%）。
对于INAA患者，EVAR可提供比OSR更好的短期生存。然而，接受EVAR治疗的患者发生IRC的风险更高。对于感染控制良好的低风险患者或被认为开放性重建高风险的患者，EVAR可被视为一种替代方案。
