Vascular Surgery Department, General University Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece.
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany.
J Endovasc Ther. 2023 Jun;30(3):336-346. doi: 10.1177/15266028221083458. Epub 2022 Mar 16.
Currently there is no robust evidence which type of bridging stent graft provides better outcomes after branched endovascular aortic repair (BEVAR). Self-expanding (SESG) and balloon-expandable (BESG) stent grafts are both commonly used to connect branches to their respective target vessels (TV). The aim of the current review was to evaluate the impact of the type of bridging stent grafts on TV outcomes during the mid-term follow-up after BEVAR.
The study protocol was registered to the PROSPERO (CRD42021274766). A search of the English literature was conducted, using PubMed and EMBASE databases via Ovid and Cochrane database via CENTRAL, from inception to June 30, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Only comparative studies on BEVAR reporting TV outcomes related to BESG vs SESG were considered eligible. Individual studies were assessed for risk of bias using the Newcastle Ottawa Scale. The of Recommendations, , Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence. The primary outcomes were primary patency, freedom from endoleak, TV instability, and re-intervention between BESG and SESG, used as bridging stents in branches. The outcomes were summarized as odds ratio along with their 95% confidence intervals (CI), through a paired meta-analysis.
Five out of 609 articles published from 2016 to 2020 were included in the analysis. In total, 1406 TV were revascularized, 547 (38.9 %) with BESGs and 859 with SESGs. The overall pooled primary patency (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.29-1.09; p=.256, I=4.24%) and freedom from branch-related endoleak (OR, 0.65; 95% CI, 0.17-1.48; p<.122, I=0.18%) did not differ between the stent types during the available follow-up (17 months, range = 12-35 months). In 4 studies (619 TV), SESG required fewer secondary interventions (OR, 1.04; 95% CI, 0.23-1.83; p=.009, I=0%) and TV instability rate was lower (OR, 0.99; 95% CI, 0.33-1.65; p=.003, I=0%) compared with BESG during the available follow-up.
BESG and SESG seem to perform similarly in terms of primary patency and branch-related endoleak during the mid-term follow-up. Current data from retrospective studies suggest that overall TV instability and re-intervention rates are favorable for SESG as bridging stent grafts in BEVAR.
目前尚无强有力的证据表明哪种类型的分支血管腔内修复（BEVAR）后使用的分支覆膜支架移植物能提供更好的结果。自膨式（SESG）和球囊扩张式（BESG）覆膜支架均常用于将分支与各自的靶血管（TV）相连。本综述的目的是评估在 BEVAR 后中期随访期间，分支覆膜支架移植物的类型对 TV 结局的影响。
本研究方案已在 PROSPERO（CRD42021274766）上注册。通过 Ovid 上的 PubMed 和 EMBASE 数据库以及 CENTRAL 上的 Cochrane 数据库，按照系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南，对截至 2021 年 6 月 30 日的英文文献进行了检索。只纳入了比较 BEVAR 中报告与 BESG 相比 SESG 相关 TV 结局的研究。使用纽卡斯尔-渥太华量表（Newcastle Ottawa Scale）评估单个研究的偏倚风险。采用推荐、评估、制定和评价（GRADE）方法评估证据质量。主要结局是原发性通畅率、无内漏、TV 不稳定和再介入，用于分支内的桥接支架。通过配对荟萃分析，将结局汇总为比值比（OR）及其 95%置信区间（CI）。
在 2016 年至 2020 年期间发表的 609 篇文章中，有 5 篇被纳入分析。共有 1406 个 TV 进行了血运重建，其中 547 个（38.9%）使用了 BESG，859 个使用了 SESG。在可获得的随访时间（17 个月，范围 12-35 个月）内，两种支架类型的总体原发性通畅率（OR，0.40；95%CI，0.29-1.09；p=.256，I=4.24%）和分支相关内漏（OR，0.65；95%CI，0.17-1.48；p<.122，I=0.18%）无显著差异。在 4 项研究（619 个 TV）中，SESG 需要的二次干预较少（OR，1.04；95%CI，0.23-1.83；p=.009，I=0%），TV 不稳定率较低（OR，0.99；95%CI，0.33-1.65；p=.003，I=0%）。
在中期随访中，BESG 和 SESG 在原发性通畅率和分支相关内漏方面似乎表现相似。来自回顾性研究的现有数据表明，在 BEVAR 中作为桥接覆膜支架，总体 TV 不稳定和再介入率对 SESG 更为有利。
