Kontopodis Nikolaos, Gavalaki Aikaterini, Galanakis Nikolaos, Kantzas Michalis, Ioannou Christos, Geroulakos George, Kakisis John, Antoniou George A
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece.
Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece.
J Endovasc Ther. 2025 Apr;32(2):276-289. doi: 10.1177/15266028231179419. Epub 2023 Jun 22.
The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients.
A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models.
Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low.
Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy.
PROSPERO, CRD42022325051Clinical ImpactUncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.
本研究旨在探讨腹主动脉瘤（AAA）的哪种治疗方法，即血管腔内修复术或开放修复术，在年轻患者中具有更好的治疗效果。
进行了一项系统评价，以确定比较年轻患者完整AAA的血管腔内修复术和开放修复术的观察性研究或随机对照试验（RCT）。使用Ovid界面检索截至2022年3月的MEDLINE、EMBASE和CENTRAL数据库。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险，最高分为9分，或使用Cochrane偏倚风险工具第2版。采用GRADE框架评估证据的确定性。主要结局为围手术期、总体和动脉瘤相关死亡率。次要结局为再次干预、住院时间和围手术期并发症。综合分析中的效应量为比值比（OR）、风险差（RD）、平均差（MD）或风险比（HR），并使用Mantel-Haenszel或逆方差统计方法及随机效应模型进行计算。
纳入了15项观察性研究和1项RCT，共报告了48976例年轻患者。年轻的定义范围为60至70岁。NOS的中位数评分为8分（范围：4 - 9分），该RCT被判定为高偏倚风险。血管腔内修复术后围手术期死亡率较低（RD：-0.01，95%CI：-0.02至-0.00），但血管腔内修复术和开放修复术之间的总体及动脉瘤相关死亡率无显著差异（HR：1.38，95%CI：0.81至2.33；HR：4.68，95%CI：0.71至31.04），再次干预的风险也是如此（HR：1.50，95%CI：0.88至2.56）。血管腔内修复术后住院时间较短（MD：-4.44天，95%CI：-4.79至-4.09），血管腔内修复术后心脏（OR：0.22，95%CI：0.13至0.35）、呼吸（OR：0.17，95%CI：0.11至0.26）和出血并发症的发生率较低（OR：0.26，95%CI：0.11至0.64）。证据水平低或非常低。
在考虑现有证据的共同决策过程中，应考虑患者的偏好和观点。对于解剖结构合适的年轻且健康的患者，可考虑血管腔内修复术。
PROSPERO，CRD42022325051临床影响年轻患者腹主动脉瘤的最佳治疗策略尚不确定。对约48976例年轻患者的荟萃分析表明，与开放手术修复相比，血管腔内动脉瘤修复术（EVAR）具有较低的围手术期死亡率和发病率，以及较短的住院时间和重症监护病房停留时间，但血管腔内修复术和开放修复术在短期至中期的总体及动脉瘤相关死亡率无显著差异。年轻患者可考虑采用血管腔内修复术。
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