降主动脉瘤和胸腹主动脉瘤开放修复及血管腔内修复术后的脊髓损伤：一项更新的系统评价和荟萃分析
Spinal cord injury after open and endovascular repair of descending thoracic aneurysm and thoracoabdominal aortic aneurysm: an updated systematic review and meta-analysis.
作者信息
Alzghari Talal, An Kevin R, Harik Lamia, Rahouma Mohamed, Dimagli Arnaldo, Perezgorvas-Olaria Roberto, Demetres Michelle, Cancelli Gianmarco, Soletti Giovanni, Lau Christopher, Girardi Leonard N, Gaudino Mario
机构信息
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY, USA.
出版信息
Ann Cardiothorac Surg. 2023 Sep 28;12(5):409-417. doi: 10.21037/acs-2023-scp-14. Epub 2023 Jul 31.
BACKGROUND
Spinal cord injury (SCI) is a rare but severe complication after open or endovascular repair of descending thoracic aneurysms (DTAs) or thoracoabdominal aortic aneurysms (TAAAs). This meta-analysis aims to provide a comprehensive assessment of SCI rates and factors associated with SCI.
METHODS
A systematic literature search was performed in September 2022 looking for studies on open and/or endovascular repair of DTA and/or TAAA published after 2018, to update the results of our previously published meta-analysis. The primary outcome was permanent SCI. Secondary outcomes were temporary SCI, 30-day and in-hospital mortality, follow-up mortality, postoperative stroke, and cerebrospinal fluid (CSF) drain-related complications. Data were pooled as proportions using inverse-variance weighting.
RESULTS
A total of 239 studies (71 new studies and 168 from our previous meta-analysis) and 61,962 patients were included. The overall pooled rate of permanent SCI was 3.3% [95% confidence interval (CI), 2.9-3.8%]. Open repair was associated with a permanent SCI rate of 4.0% (95% CI, 3.3-4.8%), and endovascular repair was associated with a permanent SCI rate of 2.9% (95% CI, 2.4-3.5%). Permanent SCI was 2.0% (95% CI, 1.2-3.3%) after DTA repair, and 4.7% (95% CI, 3.9-5.6%) after TAAA repair; permanent SCI rate was 3.8% (95% CI, 2.9-5.0%) for Crawford extent I, 13.4% (95% CI, 9.0-19.5%) for extent II, 7.1% (95% CI, 5.7-8.9%) for extent III, 2.3% (95% CI, 1.6-3.5%) for extent IV, and 6.7% (95% CI, 1.7-23.1%) for extent V TAAA aneurysms. The pooled rate of CSF drain related complications was 1.9% (95% CI, 0.8-4.7%) for severe, 0.4% (95% CI, 0.0-4.0%) for moderate, and 1.8% (95% CI, 0.6-5.6%) for minor complications.
CONCLUSIONS
Permanent SCI occurs after both endovascular and open DTA or TAAA repairs. Open repairs and TAAA repairs have higher risk of SCI compared with endovascular or DTA repairs. In particular, extent II aneurysms present the highest overall risk of SCI.
背景
脊髓损伤（SCI）是降主动脉瘤（DTA）或胸腹主动脉瘤（TAAA）开放修复或血管腔内修复术后一种罕见但严重的并发症。本荟萃分析旨在全面评估SCI发生率及与SCI相关的因素。
方法
于2022年9月进行系统文献检索，查找2018年后发表的关于DTA和/或TAAA开放和/或血管腔内修复的研究，以更新我们之前发表的荟萃分析结果。主要结局为永久性SCI。次要结局为暂时性SCI、30天和住院死亡率、随访死亡率、术后中风以及脑脊液（CSF）引流相关并发症。数据采用逆方差加权法合并为比例数据。
结果
共纳入239项研究（71项新研究和我们之前荟萃分析中的168项研究）及61,962例患者。永久性SCI的总体合并发生率为3.3%[95%置信区间（CI），2.9 - 3.8%]。开放修复的永久性SCI发生率为4.0%（95% CI，3.3 - 4.8%），血管腔内修复的永久性SCI发生率为2.9%（95% CI，2.4 - 3.5%）。DTA修复后永久性SCI发生率为2.0%（95% CI，1.2 - 3.3%），TAAA修复后为4.7%（95% CI：3.9 - 5.6%）；Crawford I型动脉瘤永久性SCI发生率为3.8%（95% CI，2.9 - 5.0%），II型为13.4%（95% CI，9.0 - 19.5%），III型为7.1%（95% CI，5.7 - 8.9%），IV型为2.3%（95% CI，1.6 - 3.5%），V型TAAA动脉瘤为6.7%（95% CI，1.7 - 23.1%）。CSF引流相关严重并发症的合并发生率为1.9%（95% CI，0.8 - 4.7%），中度并发症为0.4%（95% CI，0.0 - 4.0%），轻度并发症为1.8%（95% CI，0.6 - 5.6%）。
结论
血管腔内和开放的DTA或TAAA修复术后均会发生永久性SCI。与血管腔内或DTA修复相比，开放修复和TAAA修复发生SCI的风险更高。特别是，II型动脉瘤的SCI总体风险最高。
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