Apostolidis George, Nana Petroula, Torrealba José I, Panuccio Giuseppe, Katsargyris Athanasios, Kölbel Tilo
German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany.
Department of Vascular and Endovascular Surgery, General Hospital Nuremberg, Paracelsus Medical University, 90419 Nuremberg, Germany.
J Clin Med. 2025 Jul 23;14(15):5221. doi: 10.3390/jcm14155221.
: Bridging stent optimal choice in fenestrated and branched endovascular aortic repair (f/bEVAR) is under investigation. This systematic review and meta-analysis studied the outcomes of the BeGraft peripheral and peripheral PLUS as bridging stents in f/bEVAR. : The methodology was pre-registered to the PROSPERO (CRD420251007695). Following the PRISMA guidelines and PICO model, the PubMed, Cochrane and Embase databases were searched for observational studies and randomized control trials, in English, from 2015 to 2025, reporting on f/bEVAR patients using the second-generation BeGraft peripheral or the BeGraft peripheral PLUS balloon expandable covered stent (BECS; Bentley InnoMed, Hechingen, Germany) for bridging. The ROBINS-I assessed the risk of bias and GRADE the quality of evidence. Target vessel technical success, occlusion/stenosis, endoleak Ic/IIIc, reintervention and instability during follow-up were primary outcomes, assessed using proportional meta-analysis. : Among 1266 studies, eight were included (1986 target vessels; 1791 bridged via BeGraft); all retrospective, except one. The ROBINS-I showed that seven were at serious risk of bias. According to GRADE, the quality of evidence was "very low" for primary outcomes. Target vessel technical success was 99% (95% CI 98-100%; I = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2-5%; I = 44%), occlusion/stenosis was 1% (95% CI 1-4%; I = 8%) and endoleak Ic/IIIc was 1% (95% CI 0-3%; I = 0%). The estimated target-vessel reintervention was 2% (95% CI 2-4%; I = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0-16%; I = 0%;), 1% (95% CI 0-5%; I = 14%) and 4% (95% CI 2-7%; I = 40%), respectively. The BeGraft peripheral and peripheral PLUS BECS performed with high technical success and low instability when used for bridging in f/bEVAR. Cautious interpretation is required due to the very low quality of evidence.
带分支及开窗的主动脉腔内修复术（f/bEVAR）中桥接支架的最佳选择仍在研究中。本系统评价和荟萃分析研究了BeGraft外周型和外周增强型作为f/bEVAR桥接支架的疗效。：该方法已在PROSPERO（CRD420251007695）上预先注册。按照PRISMA指南和PICO模型，检索了PubMed、Cochrane和Embase数据库，查找2015年至2025年期间以英文发表的关于使用第二代BeGraft外周型或BeGraft外周增强型球囊扩张覆膜支架（BECS；德国黑兴根的本特利创新医疗公司）进行桥接的f/bEVAR患者的观察性研究和随机对照试验。ROBINS-I评估偏倚风险，GRADE评估证据质量。目标血管技术成功率、闭塞/狭窄、Ic/IIIc型内漏、再次干预和随访期间的不稳定性为主要结局，采用比例荟萃分析进行评估。：在1266项研究中，纳入了8项（1986条目标血管；1791条通过BeGraft进行桥接）；除1项外均为回顾性研究。ROBINS-I显示，7项存在严重偏倚风险。根据GRADE，主要结局的证据质量为“极低”。目标血管技术成功率为99%（95%CI 98-100%；I²=12%）。平均随访时间为20.2个月。目标血管不稳定性为3%（95%CI 2-5%；I²=44%），闭塞/狭窄为1%（95%CI 1-4%；I²=8%），Ic/IIIc型内漏为1%（95%CI 0-3%；I²=0%）。估计的目标血管再次干预率为2%（95%CI 2-4%；I²=12%）。腹腔干、肠系膜上动脉和肾动脉的不稳定性分别为1%（95%CI 0-16%；I²=0%）、1%（95%CI 0-5%；I²=14%）和4%（95%CI 2-7%；I²=40%）。BeGraft外周型和外周增强型BECS在用于f/bEVAR桥接时技术成功率高且不稳定性低。由于证据质量极低，需要谨慎解读。
