Systematic Review and Meta-analysis of Physician Modified Endografts for Treatment of Thoraco-Abdominal and Complex Abdominal Aortic Aneurysms.

OBJECTIVE

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).

DATA SOURCES

MEDLINE, CENTRAL, Web of Science Core Collection, Scielo, and Open Grey.

REVIEW METHODS

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.

RESULTS

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).

CONCLUSION

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.