Systematic Review and Meta-Analysis of Elective Open Conversion versus Fenestrated and Branched Endovascular Repair for Previous Non-Infected Failed Endovascular Aneurysm Repair.
作者信息
Esposito Davide, Rawashdeh Majd, Onida Sarah, Turner Benedict, Machin Matthew, Pulli Raffaele, Davies Alun H
机构信息
Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy; Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
出版信息
Eur J Vasc Endovasc Surg. 2024 Mar;67(3):393-405. doi: 10.1016/j.ejvs.2023.09.036. Epub 2023 Sep 23.
OBJECTIVE
To evaluate outcomes of patients electively undergoing fenestrated and branched endovascular repair (F/B-EVAR) or open conversion for failed previous non-infected endovascular aneurysm repair (EVAR).
DATA SOURCES
Embase, MEDLINE, Cochrane Library.
REVIEW METHOD
The protocol was prospectively registered on PROSPERO (CRD42023404091). The review followed the PRISMA guidelines; certainty was assessed through the GRADE and quality through MINORS tools. Outcomes data were pooled separately for F/B-EVAR and open conversion. A random effects meta-analysis of proportions was conducted; heterogeneity was assessed with the I statistic.
RESULTS
Thirty eight studies were included, for a total of 1 645 patients of whom 1 001 (60.9%) underwent an open conversion and 644 (39.1%) a F/B-EVAR. The quality of evidence was generally limited. GRADE certainty was judged low for 30 day death (in both groups) and F/B-EVAR technical success, and very low for the other outcomes. Pooled 30 day death was 2.3% (I 33%) in the open conversion group and 2.4% (I 0%) in the F/B-EVAR conversion group (p = .36). Technical success for F/B-EVAR was 94.1% (I 23%). The pooled 30 day major systemic complications rate was higher in the open conversion (21.3%; I 74%) than in the F/B-EVAR (15.7%; I 78%) group (p = .52). At 18 months follow up, the pooled re-intervention rate was 4.5% (I 58%) in the open conversion and 26% (I 0%) in the F/B-EVAR group (p < .001), and overall survival was 92.5% (I 59%) and 81.6% (I 68%), respectively (p = .005).
CONCLUSION
In the elective setting, and excluding infections, the early results of both open conversion and F/B-EVAR after failed EVAR appear satisfactory. Although open conversion presented with higher complication rates in the first 30 days after surgery, at follow up it seemed to be associated with fewer re-interventions and better survival compared with F/B-EVAR.
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