Hybrid management of aberrant subclavian artery: A systematic review and meta-analysis.

IF 1 4区医学 Q4 PERIPHERAL VASCULAR DISEASE

Vascular Pub Date : 2024-11-28 DOI:10.1177/17085381241303330

Ali Kordzadeh, Mohamed Imm Mouhsen, Deona Ml Chan, Arvind Singh, Vijay M Gadhvi

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引用次数: 0

Abstract

Objective: To elucidate the short- and long-term mortality, morbidity, and endoleak incidences in the hybrid management of aberrant subclavian artery (ASA).

Methods: A systematic review and meta-analysis of 99 articles comprising n = 272 cases using PRISMA were supplemented by Cohen's Kappa for assessor consistency. The analysis involved a random-effect model, odds ratios (ORs) with 95% confidence intervals, tests of heterogeneity, and probability. This review was registered with the International Prospective Register of Systematic Reviews (CRD42023405011).

Results: The 30-day mortality was 4.6% (95% CI: 1.4%-14.4%) with an overall mortality of 7.3% (95% CI: 2.9%-18.7%) demonstrating a 1.2% increase in mortality per decade of life beyond 60 years. The reported morbidity was 7.6% (95% CI: 3.7%-15.7%) and higher in males albeit higher age (p < .05) (67 vs 59 years). The endoleak incidence stood at 7.8% (95% CI: 3.3%-18.3%) with Type-I the as prominent (48%). Rupture presentation was in 3%, whilst esophageal fistulation (n = 2/3) was associated with morbidity of 66%. Treatment varied, with TEVAR and carotid-subclavian bypass being the most common modality of the choice. The median follow-up was 12 months (IQR, 1-60 months).

Conclusion: The observed incidence of mortality, morbidity, and endoleak shows the current role of the hybrid approach in managing ASA. These results emphasize the critical role of detailed surgical planning, combined endovascular and open expertise, and the necessity for a common registry to monitor long-term outcomes.

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锁骨下动脉异常的混合治疗：系统回顾和荟萃分析。

目的：探讨混合治疗锁骨下动脉（ASA）的短期和长期死亡率、发病率和内漏发生率。方法：采用PRISMA对99篇文章（n = 272例）进行系统评价和meta分析，并辅以Cohen’s Kappa评估一致性。分析包括随机效应模型、95%置信区间的优势比（ORs）、异质性检验和概率检验。本综述已在国际前瞻性系统评价注册（CRD42023405011）注册。结果：30天死亡率为4.6% (95% CI: 1.4%-14.4%)，总死亡率为7.3% (95% CI: 2.9%-18.7%)，表明60岁以上每10年的死亡率增加1.2%。报告的发病率为7.6% (95% CI: 3.7%-15.7%)，男性发病率更高，但年龄更高（p < 0.05）（67岁vs 59岁）。肠内漏发生率为7.8% (95% CI: 3.3%-18.3%)，其中i型肠内漏发生率最高（48%）。破裂的发生率为3%，而食管瘘（n = 2/3）的发病率为66%。治疗方法多种多样，TEVAR和颈动脉-锁骨下搭桥是最常见的选择。中位随访时间为12个月（IQR， 1-60个月）。结论：观察到的死亡率、发病率和内漏率显示了混合入路在ASA治疗中的作用。这些结果强调了详细手术计划的关键作用，结合血管内和开放的专业知识，以及监测长期结果的共同登记的必要性。

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

Vascular 医学-外周血管病

CiteScore

2.30

自引率

9.10%

发文量

196

审稿时长

6-12 weeks

期刊介绍： Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.