Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece.
Eur J Vasc Endovasc Surg. 2023 Feb;65(2):244-254. doi: 10.1016/j.ejvs.2022.10.033. Epub 2022 Oct 20.
To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant.
MEDLINE and Embase were searched using the Ovid interface.
A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients with non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow up. The risk of bias was assessed with the Newcastle-Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm related death. Effect measures were the hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random effects models.
Thirteen cohort studies with a total of 22 762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36 - 51). No statistically significant difference was found in the hazard of all cause mortality (HR 1.04, 95% CI 0.61 - 1.77), aneurysm related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31 - 1.41) between patients who had incomplete and complete follow up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39 - 1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance vs. those with complete surveillance showed no significant difference in all cause mortality (HR 1.10, 95% CI 0.43 - 2.80).
Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. These findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualised or risk adjusted surveillance.
比较接受血管内动脉瘤修复（EVAR）后进行监测的患者与不遵守监测要求的患者的生存率。
使用 Ovid 界面在 MEDLINE 和 Embase 上进行检索。
按照 PRISMA 指南进行系统评价。合格的研究比较了遵守 EVAR 监测要求的患者与不遵守患者的生存率。不遵守定义为未能至少参加一次 EVAR 随访。使用纽卡斯尔-渥太华量表评估偏倚风险，并使用 GRADE 框架评估证据确定性。主要结局是生存率和与动脉瘤相关的死亡。测量指标为风险比（HR）或优势比（OR）和 95%置信区间（CI），使用倒数方差或 Mantel-Haenszel 统计方法和随机效应模型计算。
纳入了 13 项队列研究，共有 22762 名患者。其中 8 项研究被认为存在高偏倚风险。不遵守 EVAR 监测要求的患者比例为 43%（95%CI 36%-51%）。在全因死亡率（HR 1.04，95%CI 0.61-1.77）、与动脉瘤相关的死亡率（HR 1.80，95%CI 0.85-3.80）或二级干预（HR 0.66，95%CI 0.31-1.41）方面，不完全随访与完全随访的患者之间无统计学差异。不遵守患者的动脉瘤破裂风险较低（OR 0.63，95%CI 0.39-1.01）。所有结局的证据确定性均为极低。对无监测与完全监测的患者进行亚组分析，全因死亡率无显著差异（HR 1.10，95%CI 0.43-2.80）。
不遵守 EVAR 监测要求的患者与遵守监测要求的患者的生存率相似。这些发现对所有 EVAR 后进行强化监测的价值提出了质疑，并强调需要进一步研究个体化或风险调整监测。
