Liu Junning, Gou Dan, Xu Kanglin, Lu Ziao, Li Peidong, Lei Yong, Wang Yongjie, Yang Yuting, Liu Shiqiang, Zhu Guiying
Department of Cardiovascular Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China.
Department of Educational Technology, Institute of Education, China West Normal University, Nanchong, China.
Int J Surg. 2025 Mar 1;111(3):2662-2674. doi: 10.1097/JS9.0000000000002230.
This systematic review and meta-analysis aimed to evaluate and compare the efficacy of endovascular versus open repair for the treatment of patients with descending thoracic aortic aneurysm (DTAA).
A systematic search of the PubMed, Embase, and Cochrane Library databases for relevant studies was performed. Outcome data, including postoperative mortality and morbidity, operative details, all-cause survival, freedom from aortic-related survival and freedom from aortic-related re-intervention, were independently extracted by two authors in a standardized way.
Twenty-nine studies comprising 49 972 patients (22 049 endovascular repair; 27 923 open repair) were included. Endovascular repair was associated with a significantly lower postoperative mortality rate [odd ratio (OR): 0.57, 95% confidence interval (CI): 0.45-0.72; I 2 = 72.58%] and morbidity. In terms of long-term survival, endovascular repair yielded better freedom from aortic-related survival [hazard ratio (HR): 0.71, 95% CI: 0.54-0.93, P = 0.012] but inferior freedom from aortic-related reintervention (HR: 2.10, 95% CI: 1.45-3.04, P < 0.001). Landmark analysis revealed that the open repair group experienced better all-cause survival beyond 16 months (HR: 1.64, 95% CI: 1.53-1.75, P < 0.001). In addition, in the subgroup of patients with intact DTAA, those who underwent open repair exhibited a higher rate of postoperative mortality (OR: 0.58, 95% CI: 0.38-0.88; I 2 = 83.34%) but had better all-cause survival beyond 7 months (HR: 1.72, 95% CI: 1.61-1.84, P < 0.001) than those who underwent endovascular repair.
Among patients treated for DTAA, endovascular repair was associated with better freedom from aortic-related survival, a lower risk for postoperative mortality and morbidity, and shorter lengths of intervention, intensive care unit stay, and hospital stay than those who underwent open repair. Open repair yielded significantly better long-term all-cause survival and freedom from aortic-related re-intervention than endovascular repair.
本系统评价和荟萃分析旨在评估和比较血管腔内修复术与开放修复术治疗降主动脉瘤（DTAA）患者的疗效。
对PubMed、Embase和Cochrane图书馆数据库进行系统检索以查找相关研究。由两位作者以标准化方式独立提取结局数据，包括术后死亡率和发病率、手术细节、全因生存率、无主动脉相关生存率以及无主动脉相关再次干预率。
纳入了29项研究，共49972例患者（血管腔内修复术22049例；开放修复术27923例）。血管腔内修复术的术后死亡率显著较低[比值比（OR）：0.57，95%置信区间（CI）：0.45 - 0.72；I² = 72.58%]，发病率也较低。在长期生存方面，血管腔内修复术的无主动脉相关生存率更高[风险比（HR）：0.71，95% CI：0.54 - 0.93，P = 0.012]，但无主动脉相关再次干预率较低（HR：2.10，95% CI：1.45 - 3.04，P < 0.001）。地标性分析显示，开放修复组在16个月后的全因生存率更好（HR：1.64，95% CI：1.53 - 1.75，P < 0.001）。此外，在DTAA完整的患者亚组中，接受开放修复术的患者术后死亡率较高（OR：0.58，95% CI：0.38 - 0.88；I² = 83.34%），但在7个月后的全因生存率优于接受血管腔内修复术的患者（HR：1.72，95% CI：1.61 - 1.84，P < 0.001）。
在接受DTAA治疗的患者中，与接受开放修复术的患者相比，血管腔内修复术的无主动脉相关生存率更高，术后死亡率和发病率风险更低，干预时间、重症监护病房住院时间和住院时间更短。开放修复术在长期全因生存率和无主动脉相关再次干预方面显著优于血管腔内修复术。
