Lin Wenxiao, Cai Fuyuan, Yan Jinliang, Lin Xiaolei
Department of Vascular Surgery, Zhangzhou Affiliated Hospital of FuJian Medical University, Zhangzhou, Fujian Province, 363000, China.
J Cardiothorac Surg. 2025 Jan 11;20(1):60. doi: 10.1186/s13019-024-03339-w.
Thoracic aortic endovascular repair (TEVAR) is the most commonly employed method for treating type B aortic dissection (TBAD). One of the primary challenges in TEVAR is the reconstruction of the left subclavian artery (LSA). Various revascularization strategies have been utilized, including branch stent techniques, fenestration techniques, chimney techniques, and hybrid techniques. Among these, the single-branched stent graft (SBSG) has emerged as one of the most promising methods. This study employs a meta-analysis to evaluate the efficacy and safety of SBSG in treating TBAD, thereby providing robust evidence to guide clinical practice.
Published literatures on the treatment of TBAD with SBSG were collected from CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science and Cochrane Library. The search period ranged from the inception of each database to December 1, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using RevMan 5.3 software.
A total of eight studies involving 660 participants were included in this meta-analysis. The results demonstrated that, compared to other surgical methods, SBSG significantly reduced the perioperative neurological complication rate (OR = 0.23, 95%CI(0.07, 0.76), P = 0.02), type I endoleak rate (OR = 0.30, 95%CI(0.15, 0.61), P = 0.001), and left upper limb ischemia rate (OR = 0.06, 95%CI(0.01, 0.49), P = 0.008). Additionally, SBSG was associated with a shorter operation time (SMD = 0.59, 95%CI(0.04, 1.14), P = 0.04). However, no significant differences were observed between SBSG and other surgical methods in terms of technique success rate (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), hospital length of stay (OR = 1.51, 95%CI(0.55, 4.14), P = 0.42), aortic false lumen thrombosis rate (OR = 1.30, 95%CI(0.55, 3.07), P = 0.56), pulmonary infection rate (OR = 0.50, 95%CI(0.16, 1.58), P = 0.24), and 30-day postoperative mortality (OR = 0.41, 95%CI(0.12, 1.35), P = 0.41).
SBSG demonstrates safety and efficacy in the treatment of TBAD by significantly reducing the perioperative neurological complexity rate, type I leakage rate, and left upper limb ischemia rate, while also decreasing operative time.
胸主动脉腔内修复术（TEVAR）是治疗B型主动脉夹层（TBAD）最常用的方法。TEVAR的主要挑战之一是左锁骨下动脉（LSA）的重建。已经采用了各种血运重建策略，包括分支支架技术、开窗技术、烟囱技术和杂交技术。其中，单分支支架移植物（SBSG）已成为最有前景的方法之一。本研究采用荟萃分析来评估SBSG治疗TBAD的疗效和安全性，从而为指导临床实践提供有力证据。
从中国知网、万方数据、维普、PubMed、Embase、Web of Science和Cochrane图书馆收集关于用SBSG治疗TBAD的已发表文献。检索期从每个数据库创建到2024年12月1日。使用纽卡斯尔-渥太华量表评估纳入研究的质量。使用RevMan 5.3软件进行荟萃分析。
本荟萃分析共纳入8项研究，涉及660名参与者。结果表明，与其他手术方法相比，SBSG显著降低了围手术期神经并发症发生率（OR = 0.23，95%CI（0.07，0.76），P = 0.02）、I型内漏发生率（OR = 0.30，95%CI（(0.15，0.61），P = 0.001）和左上肢缺血发生率（OR = 0.06，95%CI（0.01，0.49），P = 0.008）。此外，SBSG与较短的手术时间相关（SMD = 0.59，95%CI（0.04，1.14），P = 0.04）。然而，在技术成功率（OR = 1.51，95%CI（0.55，4.14），P = 0.42）、住院时间（OR = 1.51，95%CI（0.55，4.14），P = 0.42）、主动脉假腔血栓形成率（OR = 1.30，95%CI（0.55，3.07），P = 0.56）、肺部感染率（OR = 0.50，95%CI（0.16，1.58），P = 0.24）和术后30天死亡率（OR = 0.41，95%CI（0.12，1.35），P = 0.41）方面，SBSG与其他手术方法之间未观察到显著差异。
SBSG在治疗TBAD方面显示出安全性和有效性，可显著降低围手术期神经并发症发生率、I型内漏发生率和左上肢缺血发生率，同时缩短手术时间。
