Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Department of Vascular and Endovascular Surgery, University Clinic of Brandenburg/Havel, Brandenburg, Germany.
J Endovasc Ther. 2024 Feb;31(1):7-18. doi: 10.1177/15266028221109455. Epub 2022 Jul 12.
The objective of this systematic review was to report the cumulative incidence of endograft migration (EM), as well as the morbidity, reintervention rates, and mortality related to EM. This study aimed to provide evidence-based data on patient-relevant sequelae of EM after thoracic endovascular aortic repair (TEVAR) performed using contemporary aortic endografts.
A systematic electronic search of literature in MEDLINE (via PubMed), Web of Science, and Cochrane Central Register of Controlled Trials was performed. The pooled synthesis of outcomes was performed using the inverse variance method.
Seven prospective non-randomized and 4 retrospective studies, including a total of 1783 patients presenting 70 EMs, were considered for the quantitative analysis. The pooled rate of EM was 4% (95% CI, 2%-7%; range, 0.2%-11%; I2=82%); pooled morbidity rate was 31% (95% CI, 12%-59%; range, 0%-100%; I2=64%) and pooled reintervention rate was 32% (95% CI, 15%-56%; range, 0%-100%; I2=55%). The pooled mortality rate due to EM was 5% (95% CI, 1%-21%; range, 0%-40%; I2=24%).
For the first time, this meta-analysis provides pooled reference estimates of EM after TEVAR. Thus, the results hold the potential to further characterize EM after TEVAR. The clinical relevance of EM is underlined by its association with high rates of endoleak-related morbidity, reintervention, and mortality. Close standardized surveillance after TEVAR for early detection of EM and prophylaxis of its sequelae is essential.
本系统评价的目的是报告移植物内漏（EM）的累积发生率，以及与 EM 相关的发病率、再介入率和死亡率。本研究旨在提供基于证据的关于使用当代主动脉内支架进行胸主动脉腔内修复术（TEVAR）后 EM 对患者的相关后果的数据。
通过 MEDLINE（通过 PubMed）、Web of Science 和 Cochrane 对照试验中心注册库进行了系统的电子文献搜索。使用逆方差法对结果进行汇总分析。
纳入了 7 项前瞻性非随机对照研究和 4 项回顾性研究，共纳入 1783 例患者的 70 例 EM。EM 的总发生率为 4%（95%CI，2%-7%；范围，0.2%-11%；I2=82%）；合并发病率为 31%（95%CI，12%-59%；范围，0%-100%；I2=64%），再介入率为 32%（95%CI，15%-56%；范围，0%-100%；I2=55%）。因 EM 导致的死亡率为 5%（95%CI，1%-21%；范围，0%-40%；I2=24%）。
这是首次对 TEVAR 后 EM 进行荟萃分析，提供了 EM 的汇总参考估计值。因此，结果有可能进一步描述 TEVAR 后 EM。EM 与较高的内漏相关发病率、再介入和死亡率相关，突出了其临床重要性。对 TEVAR 后进行密切的标准化监测，以便早期发现 EM 并预防其后果至关重要。
