Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Endovasc Ther. 2024 Jun;31(3):421-427. doi: 10.1177/15266028221125582. Epub 2022 Sep 22.
To evaluate by meta-analysis the safety and efficacy of venous sac embolization (VSE) with or without feeding artery embolization versus feeding artery embolization (FAE) alone in the management of pulmonary arteriovenous malformations (PAVMs).
This systematic review and meta-analysis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was performed in MEDLINE, Embase, and Scopus till August 31, 2021 to identify studies comparing the safety and efficacy of VSE with or without FAE versus FAE alone in PAVMs. The success of treatment was assessed by comparing the number of PAVMs with ≥70% decrease in the size of draining vein/sac between the 2 groups. The pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using the random-effects inverse-variance model and were used to compare pooled therapeutic efficacy between the groups.
Three studies were found eligible for the meta-analysis. The included studies had a total of 169 patients (119 females and 50 males). The total number of PAVMs was 298, and hereditary hemorrhagic telangiectasia was present in 119 patients. The success of treatment was higher with VSE as compared to FAE (OR=3.54, 95% CI=1.66-7.56). The minor complications were similar in both groups, and one major complication occurred in the FAE group. More coils were used in the VSE group.
The present systematic review and meta-analysis has consolidated the evidence that VSE with or without FAE is more efficacious than FAE alone in the management of PAVMs without any increase in the associated risk of sac rupture or coil migration.
Until high-quality data from a prospective, multicentric, randomized controlled trial becomes available, the evidence consolidated by the present systematic review and meta-analysis showing the efficacy of venous sac embolization (with or without feeding artery embolization) over feeding artery embolization alone, can be used for clinical decision-making in the management of pulmonary arterio-venous malformations.
通过荟萃分析评估静脉囊栓塞（VSE）联合或不联合供血动脉栓塞（FAE）与单纯 FAE 在治疗肺动静脉畸形（PAVM）中的安全性和疗效。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行和报告。系统检索 MEDLINE、Embase 和 Scopus 数据库，检索时间截至 2021 年 8 月 31 日，以确定比较 VSE 联合或不联合 FAE 与单纯 FAE 在 PAVM 中治疗安全性和疗效的研究。通过比较两组之间引流静脉/囊大小减少≥70%的 PAVM 数量来评估治疗的成功。使用随机效应逆方差模型计算合并优势比（OR）和 95%置信区间（95%CI），并用于比较组间的合并治疗效果。
发现 3 项研究符合荟萃分析的纳入标准。纳入的研究共有 169 名患者（119 名女性和 50 名男性）。PAVM 的总数为 298 个，其中 119 名患者存在遗传性出血性毛细血管扩张症。与 FAE 相比，VSE 的治疗成功率更高（OR=3.54，95%CI=1.66-7.56）。两组的轻微并发症相似，FAE 组发生 1 例严重并发症。VSE 组使用的线圈更多。
本系统评价和荟萃分析汇总的证据表明，VSE 联合或不联合 FAE 比单纯 FAE 治疗 PAVM 更有效，且不会增加囊破裂或线圈迁移的风险。
在具有高质量数据的前瞻性、多中心、随机对照试验出现之前，本系统评价和荟萃分析汇总的证据表明静脉囊栓塞（联合或不联合供血动脉栓塞）比单纯供血动脉栓塞更有效，可用于指导 PAVM 治疗的临床决策。
