腹主动脉瘤 EVAR 术后早期开放手术转换的发生率、适应症和结果的系统回顾和荟萃分析。

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Angiology Pub Date : 2024-04-01 Epub Date: 2024-03-19 DOI:10.23736/S0392-9590.24.05153-8

Nicola Cicala, Paolo Perini, Alexandra Catasta, Anna Fornasari, Alessandro Ucci, Antonio Freyrie

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Estimated rate of cause determining EOC were: access issue in 27.7% of patients (95% CI 13.8-41.6; I2=88.14%), incorrect placement of the endograft in 20.1% (95% CI 10.2-30.0; I2=76,9%), problems with \"delivery system\" in 9.0% (95% CI 4.9-13.1; I2=0%), aorto-iliac rupture in 8.6% (95% CI 4.5-12.6; I2=0%), endoprosthesis migration in 7.9% of cases (95% CI 3.3-12.4; I2=22.96%), failure in engaging the contralateral gate in 4.8% (95% CI 1.6-8; I2=0%), \"kinking\" or \"twisting\" of endoprosthesis in 3.3% (95% CI 0.6-5.9; I2=0%), graft thrombosis in 3.2% (95% CI 0.6-5.7; I2=0%), type Ia endoleak in 2.9% (95% CI 0.4-5.4; I2=0%), type III endoleak in 2.8% (95% CI 0.3-5.3; I2=0%) and endograft infection in 2.7% (95% CI 0.3-5.2; I2=0%). Intraoperative conversion rate was 91.1% (95% CI 85.8-96.4; I2=66.01%). Early mortality rate after EOC was 14.5% (95% CI 9.1-19.9; I2=48.31%). 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引用次数: 0

摘要

导言：本研究的目的是报告血管内主动脉修补术（EVAR）后早期开放转流（EOC）的发生率、适应症和结果，EOC的定义是在首次EVAR后30天内进行的手术转流：对文献进行了系统性回顾（数据库检索：PubMed、Web Science、CSSCI、SCI）：证据获取：对文献进行了系统性回顾（数据库检索：PubMed、Web of Science、Scopus、Cochrane Library；最后一次检索为 2023 年 4 月）。纳入了至少有五名患者报告EVAR术后EOC的文章。采用随机效应模型对比例进行元分析：纳入了 17 项发表于 1999 年至 2022 年的非随机研究。共有35,970名患者曾接受过EVAR手术，其中438名患者接受了EOC手术。EOC的估计发生率为1.4%（95% CI 1.1-1.4；I2=81.66%）。具体而言，在2010年之前发表的著作中，发病率为1.8%（95% CI 1.3-2.4；I2=74.25），而在之后发表的著作中，发病率为0.9%（95% CI 0.6-1.1；I2=69.82）。加权平均年龄为 74.91 岁（95% CI 72.42-77.39；I2=83.11%）。决定 EOC 的原因估计率为：27.7% 的患者存在入路问题（95% CI 13.8-41.6；I2=88.14%），20.1% 的患者内移植物放置错误（95% CI 10.2-30.0；I2=76.9%），20.1% 的患者内移植物放置不正确（95% CI 10.2-30.0；I2=88.14%）。0；I2=76.9%），9.0%（95% CI 4.9-13.1；I2=0%）的病例存在 "输送系统 "问题，8.6%（95% CI 4.5-12.6；I2=0%）的病例存在髂主动脉破裂，7.9%（95% CI 3.3-12.4；I2=22.96%）的病例存在内假体移位。4；I2=22.96%）、4.8%（95% CI 1.6-8；I2=0%）的病例未能与对侧闸门接合、3.3%（95% CI 0.6-5.9；I2=0%）的病例出现假体 "扭结 "或 "扭曲"、3.2%（95% CI 0.6-5.9；I2=0%）的病例出现移植物血栓。2%（95% CI 0.6-5.7；I2=0%），Ia 型内漏 2.9%（95% CI 0.4-5.4；I2=0%），III 型内漏 2.8%（95% CI 0.3-5.3；I2=0%），内植物感染 2.7%（95% CI 0.3-5.2；I2=0%）。术中转换率为 91.1%（95% CI 85.8-96.4；I2=66.01%）。EOC 术后早期死亡率为 14.5% (95% CI 9.1-19.9; I2=48.31%)。平均住院时间（LOS）为11.94天（95% CI 6.718-17.172; I2=92.34%）：结论：随着时间的推移，EOC的发病率似乎在下降。EOC的原因主要与入路问题和内植物定位不正确有关。大多数 EOC 在术中进行，死亡率较高。

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Systematic review and meta-analysis of incidence, indications, and outcomes of early open conversions after EVAR for abdominal aortic aneurysms.

Introduction: The purpose of this study is to report incidence, indications, and outcomes of early open conversions (EOC) after endovascular aortic repair (EVAR), defined as surgical conversion performed within 30 days from the initial EVAR.

Evidence aquisition: A systematic review of the literature was performed (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search April 2023). Articles reporting EOC after EVAR comprising at least five patients were included. Meta-analyses of proportions were performed using a random-effects model.

Evidence synthesis: Seventeen non-randomized studies, published between 1999 and 2022, were included. A total of 35,970 patients had previously undergone EVAR, of these 438 patients underwent EOC. Estimated incidence of EOC was 1.4% (95% CI 1.1-1.4; I²=81.66%). Specifically, in the works published before 2010 the incidence was 1.8% (95% CI 1.3-2.4; I²=74.25) while for subsequent ones it was 0.9% (95% CI 0.6-1.1; I²=69.82). Weighted mean age was 74.91 years (95% CI 72.42-77.39; I²=83.11%). Estimated rate of cause determining EOC were: access issue in 27.7% of patients (95% CI 13.8-41.6; I²=88.14%), incorrect placement of the endograft in 20.1% (95% CI 10.2-30.0; I²=76,9%), problems with "delivery system" in 9.0% (95% CI 4.9-13.1; I²=0%), aorto-iliac rupture in 8.6% (95% CI 4.5-12.6; I²=0%), endoprosthesis migration in 7.9% of cases (95% CI 3.3-12.4; I²=22.96%), failure in engaging the contralateral gate in 4.8% (95% CI 1.6-8; I²=0%), "kinking" or "twisting" of endoprosthesis in 3.3% (95% CI 0.6-5.9; I²=0%), graft thrombosis in 3.2% (95% CI 0.6-5.7; I²=0%), type Ia endoleak in 2.9% (95% CI 0.4-5.4; I²=0%), type III endoleak in 2.8% (95% CI 0.3-5.3; I²=0%) and endograft infection in 2.7% (95% CI 0.3-5.2; I²=0%). Intraoperative conversion rate was 91.1% (95% CI 85.8-96.4; I²=66.01%). Early mortality rate after EOC was 14.5% (95% CI 9.1-19.9; I²=48.31%). Mean length of stay (LOS) was 11.94 days (95% CI 6.718-17.172; I²=92.34%).

Conclusions: The incidence of EOC seems to decrease over time. Causes of EOC were mainly related to access problems and incorrect positioning of the endograft. Most of the EOC were performed intraoperatively carrying a high mortality rate.

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来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).