Vascular Surgery, Galway University Hospital, Galway, Ireland.
Biomedical Engineering, Vascular and Endovascular Surgery, National University of Ireland Galway, Galway, Ireland.
Cochrane Database Syst Rev. 2022 Apr 1;4(4):CD012926. doi: 10.1002/14651858.CD012926.pub2.
Thoracoabdominal aortic aneurysms (TAAAs) are a life-threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment options for patients, however, due to the lack of clinical trials comparing these, the optimum treatment option is unknown.
To assess the effectiveness and safety of endovascular repair versus conventional OSR for the treatment of TAAAs.
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.
We considered all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing endovascular repair to OSR for TAAAs for inclusion in the review. The main outcomes of interest were prevention of aneurysm rupture (participants without aneurysm rupture up to 5 years from intervention), aneurysm-related mortality (30 days and 12 months), all-cause mortality, spinal cord ischaemia (paraplegia, paraparesis), visceral arterial branch compromise causing mesenteric ischaemia or renal failure, and rate of reintervention.
Two review authors independently screened all titles and abstracts identified from the searches to identify those that met the inclusion criteria. We planned to undertake data collection, risk of bias assessment, and analysis in accordance with Cochrane recommendations. We planned to assess the certainty of the evidence using GRADE.
No RCTs or CCTs met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS: Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of endovascular compared to OSR in patients with TAAAs and are unable to provide any evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs addressing this objective are necessary, however conducting such studies will be logistically and ethically challenging for this life-threatening disease.
胸主动脉腹主动脉瘤（TAAA）是一种危及生命的疾病，目前仍难以治疗。血管内治疗和开放手术修复（OSR）为患者提供了治疗选择，但由于缺乏比较这些治疗方法的临床试验，因此尚不清楚最佳的治疗选择。
评估血管内修复与传统 OSR 治疗 TAAA 的效果和安全性。
Cochrane 血管专业信息员检索了 Cochrane 血管特刊登记处、CENTRAL、MEDLINE、Embase、CINAHL 和 AMED 数据库以及世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov 试验注册库，检索日期截至 2021 年 4 月 26 日。我们还检索了从电子检索中获取的相关文章的参考文献，以查找其他引用。
我们考虑了所有发表和未发表的比较血管内修复与 OSR 治疗 TAAA 的随机对照试验（RCT）和对照临床试验（CCT）纳入本综述。主要观察指标是预防动脉瘤破裂（在干预后 5 年内无动脉瘤破裂的参与者）、动脉瘤相关死亡率（30 天和 12 个月）、全因死亡率、脊髓缺血（截瘫、截瘫）、内脏动脉分支受损导致肠系膜缺血或肾衰竭、以及再干预率。
两位综述作者独立筛选了从搜索中确定的所有标题和摘要，以确定符合纳入标准的标题和摘要。我们计划按照 Cochrane 建议进行数据收集、风险偏倚评估和分析。我们计划使用 GRADE 评估证据的确定性。
没有 RCT 或 CCT 符合本综述的纳入标准。
由于缺乏 RCT 或 CCT，我们无法确定血管内治疗与 OSR 治疗 TAAA 患者的安全性和有效性，也无法为这一组患者提供任何关于最佳手术干预的证据。需要高质量的 RCT 或 CCT 来解决这个问题，但对于这种危及生命的疾病，开展此类研究在操作上和伦理上都具有挑战性。
