Fenestrated endovascular repair for abdominal aortic aneurysms.

IF 8.8 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Davina Daudu, Paris L Cai, Abhishekh Srinivas, Lawrence Mj Best, Jane Cross, Christopher J Hammond, Toby Richards
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引用次数: 0

Abstract

Background: Abdominal aortic aneurysms (AAAs) are abnormal dilatations of the aorta that most commonly affect its infrarenal segment, but can become more difficult to repair when they are close to or next to the renal arteries. The optimum treatment for these complex AAAs is unknown. One option is fenestrated endovascular aneurysm repair (FEVAR), which involves using fenestrations or scallops in the graft to facilitate access to the visceral arteries.

Objectives: To assess the benefits and harms of complex stent-graft fenestrated endovascular aneurysm repair (FEVAR) versus open surgical repair (OSR) or conservative (non-operative) management for people with complex AAAs.

Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov without language, publication year or publication status restrictions (published, unpublished, in press or in progress) on 28 March 2023.

Selection criteria: We considered all randomised controlled trials (RCTs) and quasi-RCTs, comparing treatment of complex AAA with FEVAR versus open surgical repair or conservative management in adults undergoing primary repair of complex AAA.

Data collection and analysis: Two review authors independently screened studies obtained from the search for potential inclusion in the review, in accordance with the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes were all-cause mortality (30 days and one year), aneurysm-related mortality at one year and length of hospital stay. Secondary outcomes were renal dysfunction at one year, reintervention rate at one year, visceral vessel patency at 30 days and one year, participant-reported health-related quality of life at one year, adverse events at one year and aneurysm-related mortality at 30 days.

Main results: We found no studies fulfilling the inclusion criteria.

Authors' conclusions: We did not identify eligible RCTs or quasi-RCTs that compared treatment of complex AAAs with FEVAR versus open surgical repair or conservative management. This is a difficult area in which to conduct research due to low incidence rates and aneurysm heterogeneity. Future studies could consider commissioning agreements mandating patient inclusion in studies to make the generation of high-quality evidence in this area feasible.

腹主动脉瘤开窗血管内修复术。
背景:腹主动脉瘤(AAAs)是主动脉的异常扩张,最常影响其肾下段,但当它们靠近或靠近肾动脉时,可能变得更难以修复。这些复杂的AAAs的最佳处理方法尚不清楚。一种选择是开窗血管内动脉瘤修复(FEVAR),它涉及在移植物中使用开窗或扇贝,以方便进入内脏动脉。目的:评估复杂支架移植开窗血管内动脉瘤修复(FEVAR)与开放手术修复(OSR)或保守(非手术)治疗复杂AAAs患者的利弊。检索方法:Cochrane血管信息专家于2023年3月28日检索了Cochrane血管专科注册、CENTRAL、MEDLINE、Embase和CINAHL(护理和联合健康文献累积索引)数据库、世界卫生组织国际临床试验注册平台和ClinicalTrials.gov,没有语言、出版年份或出版状态限制(已发表、未发表、已出版或正在出版)。选择标准:我们考虑了所有随机对照试验(rct)和准rct,比较复杂AAA合并FEVAR治疗与开放性手术修复或保守治疗对成人复杂AAA初级修复的影响。数据收集和分析:根据Cochrane干预措施系统评价手册,两位综述作者独立筛选了从研究中获得的潜在纳入本综述的研究。主要结局是全因死亡率(30天和1年)、1年动脉瘤相关死亡率和住院时间。次要结局是1年时肾功能不全、1年时再干预率、30天和1年时内脏血管通畅、1年时参与者报告的健康相关生活质量、1年时不良事件和30天的动脉瘤相关死亡率。主要结果:我们没有发现符合纳入标准的研究。作者的结论:我们没有确定符合条件的随机对照试验或准随机对照试验,比较复杂AAAs合并FEVAR治疗与开放手术修复或保守治疗。由于发病率低和动脉瘤异质性,这是一个很难进行研究的领域。未来的研究可以考虑委托协议,强制将患者纳入研究,以便在该领域产生高质量的证据。
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
CiteScore
10.60
自引率
2.40%
发文量
173
审稿时长
1-2 weeks
期刊介绍: The Cochrane Database of Systematic Reviews (CDSR) stands as the premier database for systematic reviews in healthcare. It comprises Cochrane Reviews, along with protocols for these reviews, editorials, and supplements. Owned and operated by Cochrane, a worldwide independent network of healthcare stakeholders, the CDSR (ISSN 1469-493X) encompasses a broad spectrum of health-related topics, including health services.
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