Outcomes of advanced EVAR versus open surgery in the management of complex abdominal aortic aneurysm repair: A systematic review and meta-analysis.

IF 0.7 Q3 Medicine

ASIAN CARDIOVASCULAR & THORACIC ANNALS Pub Date : 2024-06-17 DOI:10.1177/02184923241262847

Putu Febry Krisna Pertiwi, I Wayan Sudarma, Gusti Ngurah Prana Jagannatha, Anastasya Maria Kosasih, Cokorda Istri Dyah Yustika Dewi, I Gusti Agung Angga Wijaya

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引用次数: 0

Abstract

Background: Open surgery is still acknowledged as the gold standard for complex abdominal aortic aneurysm (c-AAA). Recently, advanced-endovascular aortic aneurysm repair (EVAR) for c-AAA has been developed, but its effectiveness compared to open surgery is still unclear.

Method: A systematic search was performed on the MEDLINE through PubMed and ScienceDirect databases. The search was aimed to investigate outcomes of both fenestrated- and chimney-EVAR (consider as advanced EVAR) compared to open surgery in c-AAA. Outcomes included postoperative complications, 30-day mortality, long-term mortality, and reintervention rate. Data were collected using the Mantel-Haenszel fixed effects model with relative risk (RR) as the effect size with 95% confidence interval (CI).

Results: A total of 25 studies (n = 12,845 patients) were included in our study. The results demonstrated that advanced-EVAR correlated with diminished postoperative complications (RR 0.53; 95% CI 0.49-0.57; p < 0.001) compared to open surgery. Advanced-EVAR was associated with lower 30-day mortality compared to open surgery (RR 0.66; 95% CI 0.53-0.82; p < 0.001). Subgroup analysis revealed that fenestrated-EVAR resulted in superior outcomes (p < 0.001), whereas the chimney-EVAR subgroup did not show significant differences (p = 0.79), compared to open surgery in terms of 30-day mortality. Unfortunately, advanced-EVAR was associated with a higher long-term mortality rate (RR 1.46; 95% CI 1.20-1.78; p < 0.001) and a higher reintervention rate (RR 1.26; 95% CI 1.01-1.59; p = 0.04) compared to open surgery.

Conclusion: Advanced EVAR, especially fenestrated-EVAR, presented better short-term outcomes compared to open surgery; however, it failed to demonstrate superiority over open surgery in improving long-term outcomes.

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在复杂腹主动脉瘤修补术中，高级 EVAR 与开放手术的疗效对比：系统回顾和荟萃分析。

背景：开腹手术仍被公认为治疗复杂腹主动脉瘤（c-AAA）的金标准。最近，针对 c-AAA 的先进血管内主动脉瘤修补术（EVAR）得到了发展，但与开放手术相比，其有效性仍不明确：方法：通过 PubMed 和 ScienceDirect 数据库对 MEDLINE 进行了系统性检索。方法：通过PubMedline和ScienceDirect数据库对MEDLINE进行了系统性检索，旨在研究与开腹手术相比，栅栏式EVAR和烟囱式EVAR（被认为是高级EVAR）对c-AAA的治疗效果。结果包括术后并发症、30 天死亡率、长期死亡率和再介入率。数据收集采用Mantel-Haenszel固定效应模型，以相对风险（RR）作为效应大小和95%置信区间（CI）：我们的研究共纳入了 25 项研究（n = 12,845 例患者）。结果表明，就 30 天死亡率而言，与开放手术相比，晚期 EVAR 可减少术后并发症（RR 0.53；95% CI 0.49-0.57；p p p p = 0.79）。遗憾的是，与开腹手术相比，晚期EVAR的长期死亡率更高（RR 1.46；95% CI 1.20-1.78；P P = 0.04）：结论：先进的EVAR，尤其是栅栏式EVAR，与开腹手术相比，短期疗效更好；但在改善长期疗效方面，先进的EVAR未能显示出优于开腹手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ASIAN CARDIOVASCULAR & THORACIC ANNALS Multiple-

CiteScore

1.30

自引率

0.00%

发文量

期刊介绍： The Asian Cardiovascular and Thoracic Annals is an international peer-reviewed journal pertaining to cardiovascular and thoracic medicine. Besides original clinical manuscripts, we welcome research reports, product reviews, reports of new techniques, and findings of special significance to Asia and the Pacific Rim. Case studies that have significant novel original observations, are instructive, include adequate methodological details and provide conclusions. Workshop proceedings, meetings and book reviews, letters to the editor, and meeting announcements are encouraged along with relevant articles from authors.