Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany.
Vascular Surgery Department, Ludwig Maximilian University Hospital, Munich, Germany.
Eur J Vasc Endovasc Surg. 2022 Aug-Sep;64(2-3):188-199. doi: 10.1016/j.ejvs.2022.04.015. Epub 2022 Apr 25.
To perform a systematic review and meta-analysis of the outcomes of physician modified endografts (PMEG) for the treatment of thoraco-abdominal (TAAA) and complex abdominal aortic aneurysms (C-AAA).
MEDLINE, CENTRAL, Web of Science Core Collection, Scielo, and Open Grey.
The databases were searched from inception to July 2021 for studies reporting on outcomes of PMEGs for TAAA or C-AAA repair. A systematic review was conducted (protocol CRD42021267856) and data were pooled using a random effects model of proportions. The outcomes analysed were major adverse events at 30 days (30 day mortality, myocardial infarction, respiratory failure requiring prolonged ventilation [> 24 hours or re-intubation], renal failure requiring dialysis, bowel ischaemia requiring surgery, major stroke, or definitive paraplegia); technical success; 30 day mortality; ruptures; spinal cord ischaemia; endoleaks; re-interventions; and target vessel patency.
Twenty studies were included. Overall study quality assessment was found to be low. Overall, 909 PMEGs were reported and analysed. Regarding aneurysm location (n = 867), 222 patients had extent I - III TAAAs and 645 had C-AAA or extent IV TAAA. Regarding presentation, 14 studies reported whether the patients were treated in an elective or urgent setting (n = 782). Overall, 500 (63.9%) patients were treated in an elective setting and 282 (36.1%) in an urgent setting. Major adverse events (at 30 days) occurred in 15.5% of patients (95% confidence interval [CI] 10.8 - 20.8; I = 63%, 135/832 cases): 11.6% (95% CI 8.1 - 15.7; I = 0%, 23/280 cases) for elective patients and 24.6% for urgent (95% CI 14.1 - 36.6; I = 65%, 50/192 cases). Overall technical success was 97.2% (95% CI 95.4 - 98.7; I = 0%, 587/611 cases): 98.0% (95% CI 92.1 - 100; I = 0%, 106/113cases) for extent I - III TAAAs and 99.4% (95% CI 97.5 - 100; I = 0%, 317/324 cases) for C-AAA and extent IV TAAAs. Regarding technique, technical success was 96.1% for fenestrated endovascular repair (FEVAR; 95% CI 93.2 - 98.4; I = 0%, 313/329 cases) and 99.8% for FEVAR/branched endovascular repair (95% CI 99.8 - 100; I = 0%, 17/18 cases).
Physician modified fenestrated or branched grafts for endovascular aortic repair seem feasible and safe in the short term. However, the quality of the available data is low, which highlights the need for better and more accurate data regarding this technique.
对医生改良血管内移植物（PMEG）治疗胸腹主动脉瘤（TAAA）和复杂腹主动脉瘤（C-AAA）的结果进行系统评价和荟萃分析。
MEDLINE、CENTRAL、Web of Science 核心合集、Scielo 和 Open Grey。
从数据库建立到 2021 年 7 月检索了报告 PMEG 治疗 TAAA 或 C-AAA 修复结果的研究。进行了系统评价（方案 CRD42021267856），并使用比例的随机效应模型对数据进行了汇总。分析的结果是 30 天的主要不良事件（30 天死亡率、心肌梗死、需要长时间通气[>24 小时或重新插管]的呼吸衰竭、需要透析的肾衰竭、需要手术的肠缺血、主要中风或明确性截瘫）；技术成功率；30 天死亡率；破裂；脊髓缺血；内漏；再干预；和靶血管通畅性。
纳入了 20 项研究。总体研究质量评估发现质量较低。总体而言，报告和分析了 909 个 PMEG。关于动脉瘤位置（n=867），222 例患者有 I-III 型 TAAA，645 例有 C-AAA 或 IV 型 TAAA。关于表现，14 项研究报告了患者是在择期还是紧急情况下接受治疗（n=782）。总体而言，500（63.9%）例患者在择期情况下接受治疗，282（36.1%）例患者在紧急情况下接受治疗。主要不良事件（30 天）发生在 15.5%的患者中（95%置信区间[CI]10.8-20.8；I=63%，832 例中有 135 例）：11.6%（95%CI8.1-15.7；I=0%，280 例中有 23 例）择期患者和 24.6%为紧急情况（95%CI14.1-36.6；I=65%，192 例中有 50 例）。总体技术成功率为 97.2%（95%CI95.4-98.7；I=0%，611 例中有 587 例）：98.0%（95%CI92.1-100%；I=0%，113 例中有 106 例）用于 I-III 型 TAAA 和 99.4%（95%CI97.5-100%；I=0%，324 例中有 317 例）用于 C-AAA 和 IV 型 TAAA。关于技术，腔内修复的 fenestrated 血管内移植物（FEVAR）的技术成功率为 96.1%（95%CI93.2-98.4%；I=0%，329 例中有 313 例），FEVAR/branched 血管内修复的技术成功率为 99.8%（95%CI99.8-100%；I=0%，18 例中有 17 例）。
在短期内，医生改良的血管内开窗或分支移植物似乎是可行和安全的。然而，可用数据的质量较低，这突显了需要更好和更准确的数据来描述这种技术。
