Angelos Karelis, Tilo Kölbel, Tara Mastracci, Athanasios Katsargyris, Stephan Haulon, Nikolaos Tsilimparis, George A Antoniou
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引用次数: 0
Abstract
Objective: This systematic review aimed to assess clinical outcomes of branched endovascular aortic repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR).
Data sources: A systematic literature review was performed using the electronic bibliographic databases MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2024.
Review methods: The review was designed and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported death, technical failure, primary patency of target vessels (TVs), TV related complications, branch related re-interventions, and spinal cord ischaemia (SCI). Risk of bias was evaluated with the ROBINS-I tool.
Results: Twenty seven observational studies reporting a total of 1 780 patients treated with BEVAR and 6 633 TVs were included. A total of 386 patients (84.3%) were electively treated with iBEVAR while 72 (15.6%) were urgently treated vs. 845 (63.2%) and 491 (36.7%) with oBEVAR, respectively. The pooled estimate of 30 day mortality was 4.9% (95% confidence interval [CI] 2.9 - 8.2%) for iBEVAR and 7.6% (95% CI 4.9 - 11.7%) for oBEVAR. Overall mortality rates were 13.8% (95% CI 9.7 - 19.1%) for iBEVAR vs. 15.4% (95% CI 10.6 - 21.9%) for oBEVAR. The rate of SCI was 6.5% (95% CI 4.2 - 10.0%) in iBEVAR compared with 12.9% (95% CI 9.6 - 17.1%) in oBEVAR. Primary TV patency was similar between iBEVAR (97.3%, 95% CI 94.8 - 98.6%) and oBEVAR (97.6%, 95% CI 95.3 - 98.7%). Target vessel related complication rates were 2.9% (95% CI 2.0 - 4.1%) in iBEVAR vs. 3.9% (95% CI 2.7 - 5.6%) in oBEVAR. Technical failure rates were 4.1% (95% CI 2.4 - 6.9%) for iBEVAR vs. 5.7% (95% CI 3.5 - 9.1%) for oBEVAR. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty was low or very low for all outcomes.
Conclusion: Branched endovascular aortic aneurysm repair with inner and inner/outer branches has been used in elective and urgent cases, as well as across a variety of anatomies, with both designs demonstrating satisfactory clinical outcomes.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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