Hu Zhongzhou, Zhang Zheng, Liu Hui, Chen Zhong
Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Front Cardiovasc Med. 2022 May 31;9:901193. doi: 10.3389/fcvm.2022.901193. eCollection 2022.
To investigate the safety and efficacy of total endovascular repair for thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched stent-grafts.
The MEDLINE, EMBASE, and Cochrane databases were searched between January 2001 and December 2021 to identify literature relevant to the use of fenestrated and branched endografts for the treatment of TAAAs. Studies with <4 cases and those on juxtarenal or pararenal aortic aneurysms were excluded. Meta-analyses were conducted to evaluate spinal cord ischemia (SCI), irreversible SCI, renal insufficiency, dialysis, endoleak, reintervention, target vessel patency, 30-day mortality and overall mortality. Fourteen studies comprising 1,114 patients (mean age 72.42 years, 847 men) were selected. The mean TAAA diameter was 67 mm. The Crawford TAAA classification was type I-III in 759 cases, type IV in 344 cases, and type V in 10 cases. Outcomes of the meta-analysis are reported as proportions and 95% confidence intervals (CIs).
The pooled rates for 30-day mortality and overall mortality were 6% and 18%, respectively. The pooled rate for technical success was 94% (95% CI, 93-96%), for SCI was 8% (95% CI, 7-10%), for irreversible SCI was 6% (95% CI, 4-7%), for reversible SCI was 5% (95% CI, 4-6%), for reversible SCI was 2% (95% CI, 2-3%), for renal insufficiency was 7% (95% CI, 5-10%), for dialysis was 3% (95% CI, 2-4%), for target vessel patency was 98% (95% CI, 97-99%), and for reintervention was 15% (95% CI, 9-24%).
Fenestrated and branched endografts for the treatment of TAAAs are safe and effective with acceptable early results. Lifelong regular follow-up and additional prospective studies are necessary to substantiate whether this technique is valid.
探讨使用开窗和分支型覆膜支架对胸腹主动脉瘤（TAAA）进行全腔内修复的安全性和有效性。
检索2001年1月至2021年12月期间的MEDLINE、EMBASE和Cochrane数据库，以确定与使用开窗和分支型腔内移植物治疗TAAA相关的文献。排除病例数少于4例的研究以及关于肾周或肾旁主动脉瘤的研究。进行荟萃分析以评估脊髓缺血（SCI）、不可逆性SCI、肾功能不全、透析、内漏、再次干预、靶血管通畅情况、30天死亡率和总死亡率。选择了14项研究，共1114例患者（平均年龄72.42岁，男性847例）。TAAA的平均直径为67mm。Crawford TAAA分类中，I - III型759例，IV型344例，V型10例。荟萃分析的结果以比例和95%置信区间（CI）报告。
30天死亡率和总死亡率的合并率分别为6%和18%。技术成功率的合并率为94%（95%CI，93 - 96%），SCI为8%（95%CI，7 - 10%），不可逆性SCI为6%（95%CI，4 - 7%），可逆性SCI为5%（95%CI，4 - 6%），可逆性SCI为2%（95%CI，
