Wu Haoliang, Zhang Liwei, Li Mingxing, Wei Shunbo, Zhang Cong, Bai Hualong
Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, China.
Front Surg. 2022 Apr 29;9:879682. doi: 10.3389/fsurg.2022.879682. eCollection 2022.
Endovascular treatment of juxtarenal or pararenal abdominal aortic aneurysms is more popular than open surgery, mainly because it reduces perioperative mortality and morbidity. The custom-made fenestrated devices need to be tailored to each patient, so these devices require extra manufacturing and shipping time. The increased wait time may increase the risk of aneurysm rupture in some patients. In some situations, "Off-the-shelf" (OTS) fenestrated grafts can be used. The Cook Zenith p-Branch device (William Cook Australia, Brisbane, Australia) is a relatively common OTS. This study aimed to systematically evaluate all published experiences with p-Branch.
We searched PubMed, Embase, and Cochrane to find works of literature that reported on the outcomes of patients treated with the p-Branch stent-grafts. Then we conducted an assessment of quality and meta-analysis of the results. The primary endpoints were the application rate of p-Branch stent-graft (type A, B), technical success rate, and early re-intervention rate. We estimated pooled proportions and 95% CIs.
Initial search of the literature included 111 articles, of which 7 studies were included in the end. A total of 260 patients were enrolled in these studies, and 218 patients were eventually treated with p-Branch. The pooled application rate of type A devices was 48% (95% CI, 29-67%), and pooled application rate of type B devices was 30% (95% CI, 16-44%). The pooled technical success rate was 87% (95% CI, 75-98%). The early re-intervention rate was 10% (95% CI, 3-17%). Midterm renal infarct rate (after 30 days) was 3% (95% CI, 0-6%). Midterm re-intervention rate (after 30 days) was 30% (95% CI, 3-57%). Midterm renal failure rate (after 30 days) was 6% (95% CI, 2-10%).
This pooled analysis indicated an acceptable technical success rate after p-Branch stent-graft implantation, with early and midterm re-intervention rate and renal failure rate that cannot be ignored. The p-Branch repair of juxtarenal abdominal aortic aneurysms may be an appropriate and safe option, especially in emergency situations.
肾旁或肾周腹主动脉瘤的血管内治疗比开放手术更受欢迎，主要是因为它降低了围手术期死亡率和发病率。定制的开窗装置需要根据每个患者进行量身定制，因此这些装置需要额外的制造和运输时间。等待时间的增加可能会增加一些患者动脉瘤破裂的风险。在某些情况下，可以使用“现货”（OTS）开窗移植物。Cook Zenith p-Branch装置（澳大利亚布里斯班的William Cook Australia公司）是一种相对常见的OTS。本研究旨在系统评价所有已发表的关于p-Branch的经验。
我们检索了PubMed、Embase和Cochrane，以查找报告p-Branch支架移植物治疗患者结局的文献。然后我们对结果进行了质量评估和荟萃分析。主要终点是p-Branch支架移植物（A型、B型）的应用率、技术成功率和早期再次干预率。我们估计了合并比例和95%置信区间。
初步文献检索包括111篇文章，最终纳入7项研究。这些研究共纳入260例患者，最终218例患者接受了p-Branch治疗。A型装置的合并应用率为48%（95%CI，29-67%），B型装置的合并应用率为30%（95%CI，16-44%）。合并技术成功率为87%（95%CI，75-98%）。早期再次干预率为10%（95%CI，3-17%）。中期肾梗死率（30天后）为3%（95%CI，0-6%）。中期再次干预率（30天后）为30%（95%CI，3-57%）。中期肾衰竭率（30天后）为6%（95%CI，2-10%）。
这项汇总分析表明，p-Branch支架移植物植入术后技术成功率可以接受，但早期和中期再次干预率以及肾衰竭率不容忽视。肾旁腹主动脉瘤的p-Branch修复可能是一种合适且安全的选择，尤其是在紧急情况下。
