German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany.
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany; Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece.
J Vasc Surg. 2024 May;79(5):1251-1261.e4. doi: 10.1016/j.jvs.2023.09.026. Epub 2023 Sep 25.
Despite open surgical repair (OSR) of abdominal aortic aneurysms being considered as a durable solution, disease progression and para-anastomotic aneurysms may require further repair, and fenestrated and branched endovascular aneurysm repair (F/BEVAR) may be applied to address these pathologies. The aim of this systematic review was to assess technical success, mortality, and morbidity (acute kidney injury, spinal cord ischemia) at 30 days, and mortality and reintervention rates during the available follow-up, in patients managed with F/BEVAR after previous OSR.
The PRISMA statement was followed, and the study was pre-registered to the PROSPERO (CRD42022363214). The English literature was searched, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, through November 30, 2022. Observational studies and case series with ≥5 patients (2000-2022), reporting on F/BEVAR outcomes after OSR, were considered eligible. The Newcastle-Ottawa Scale and GRADE were used to assess the risk of bias and quality of evidence. The primary outcome was technical success, mortality, and morbidity at 30 days. Data on the outcomes of interest were synthesized using proportional meta-analysis.
The initial search yielded 1694 articles. Eight retrospective studies (476 patients) were considered eligible. In 78.3% of cases, disease progression set the indication for reintervention. Technical success was estimated at 96% (95% confidence interval [CI], 89%-98%; I = 0%; 95% prediction interval [PI], 79%-99%). Thirty-day mortality was 2% (95% CI, 1%-9%; I = 0%; 95% PI, 0%-28%). The estimated spinal cord ischemia and acute kidney injury rates were 3% (95% CI, 1%-9%; I = 0%; 95% PI, 0%-30%) and 6% (95% CI, 2%-15%; I = 0%; 95% PI, 1%-40%), respectively. During follow-up, overall mortality was 5% (95% CI, 2%-12%; I = 34%; 95% PI, 0%-45%) and aorta-related mortality was 1% (95% CI, 0%-2%; I = 0%; 95% PI, 0%-3%). The rate of reinterventions was 16% (95% CI, 9%-26%; I = 22%; 95% PI, 3%-50%).
According to the available literature, F/BEVAR after OSR may be performed with high technical success and low mortality and morbidity during the perioperative period. Follow-up aortic-related mortality was 1%, whereas the reintervention rates were within the standard range following F/BEVAR.
尽管开放性手术修复（OSR）被认为是治疗腹主动脉瘤的一种持久解决方案，但疾病进展和吻合口旁动脉瘤可能需要进一步修复，而腔内开窗和分支血管修复（F/BEVAR）可用于解决这些病变。本系统评价的目的是评估既往接受 OSR 治疗的患者再次接受 F/BEVAR 治疗后 30 天的技术成功率、死亡率和发病率（急性肾损伤、脊髓缺血），以及在可用随访期间的死亡率和再干预率。
遵循 PRISMA 声明，并在 PROSPERO（CRD42022363214）上进行了预先注册。通过 Ovid 检索 MEDLINE、EMBASE 和 CENTRAL 数据库中的英文文献，检索时间截至 2022 年 11 月 30 日。纳入了观察性研究和病例系列研究，至少有 5 例患者（2000-2022 年），报告了 OSR 后 F/BEVAR 的结局。使用纽卡斯尔-渥太华量表和 GRADE 评估偏倚风险和证据质量。主要结局是 30 天的技术成功率、死亡率和发病率。使用比例荟萃分析综合了感兴趣结局的数据。
最初的搜索结果为 1694 篇文章。8 项回顾性研究（476 例患者）被认为符合纳入标准。在 78.3%的病例中，疾病进展是再次干预的指征。技术成功率估计为 96%（95%置信区间 [CI]，89%-98%；I=0%；95%预测区间 [PI]，79%-99%）。30 天死亡率为 2%（95% CI，1%-9%；I=0%；95% PI，0%-28%）。估计脊髓缺血和急性肾损伤的发生率分别为 3%（95% CI，1%-9%；I=0%；95% PI，0%-30%）和 6%（95% CI，2%-15%；I=0%；95% PI，1%-40%）。在随访期间，总体死亡率为 5%（95% CI，2%-12%；I=34%；95% PI，0%-45%），主动脉相关死亡率为 1%（95% CI，0%-2%；I=0%；95% PI，0%-3%）。再干预率为 16%（95% CI，9%-26%；I=22%；95% PI，3%-50%）。
根据现有文献，OSR 后行 F/BEVAR 治疗可能具有较高的技术成功率，围手术期死亡率和发病率较低。随访期间主动脉相关死亡率为 1%，而 F/BEVAR 后再干预率处于标准范围内。
