Diana Lopes, José Oliveira-Pinto, Armando Mansilha
{"title":"近端短颈动脉瘤FEVAR和开腹手术后的中期结果：系统评价和比较研究的荟萃分析。","authors":"Diana Lopes, José Oliveira-Pinto, Armando Mansilha","doi":"10.23736/S0392-9590.24.05283-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks.</p><p><strong>Evidence acquisition: </strong>PubMed, Web of Science and Scopus electronic databases were searched for studies referring to fenestrated endovascular aneurysm repair (FEVAR) or open surgery (OSR) in patients with infrarenal abdominal aortic aneurysms with neck length <15 mm. The primary endpoint of interest was early mortality. Secondary outcomes included major adverse cardiovascular events (MACE), bowel ischemia, acute kidney injury (AKI), late mortality and secondary interventions.</p><p><strong>Evidence synthesis: </strong>Overall, 21 studies were included, with a total of 3084 patients (1157 FEVAR and 1927 OSR). The pooled rate of early mortality following FEVAR was 2.7% (95%CI: 1.6, 4.0; I<sup>2</sup>=27.7%), compared with 3.7% (95%CI: 1.9, 6.0; I<sup>2</sup>=78.1%) after OSR. Comparative studies demonstrated no significant differences in 30-day mortality (odds ratio [OR] 0.79; 95%CI: 0.37, 1.68). A decreased risk of postoperative MACE (OR=0.51; 95%CI: 0.28, 0.95) and bowel ischemia (OR=0.30; 95%CI: 0.11, 0.86) was observed in FEVAR patients although no significant differences were seen regarding AKI (OR=0.62; 95%CI: 0.23, 1.67). Late mortality (OR=1.68; 95%CI: 1.03, 2.74) and reintervention risk (OR=4.17; 95%CI: 2.05, 8.50) were both significantly higher in FEVAR group.</p><p><strong>Conclusions: </strong>FEVAR and OSR showed no statistically significant differences in postoperative mortality in the treatment of patients with AAA with short neck length, despite lower morbidity in the former. Oppositely, FEVAR present with greater mortality and reintervention risk in the midterm. Randomized controlled trials are needed to provide secure recommendations towards preferential use of either technique for juxtarenal AAA repair.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"597-605"},"PeriodicalIF":1.5000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Midterm results after FEVAR and open surgery for infrarenal aortic aneurysms with short proximal necks: systematic review with meta-analysis of comparative studies.\",\"authors\":\"Diana Lopes, José Oliveira-Pinto, Armando Mansilha\",\"doi\":\"10.23736/S0392-9590.24.05283-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks.</p><p><strong>Evidence acquisition: </strong>PubMed, Web of Science and Scopus electronic databases were searched for studies referring to fenestrated endovascular aneurysm repair (FEVAR) or open surgery (OSR) in patients with infrarenal abdominal aortic aneurysms with neck length <15 mm. The primary endpoint of interest was early mortality. Secondary outcomes included major adverse cardiovascular events (MACE), bowel ischemia, acute kidney injury (AKI), late mortality and secondary interventions.</p><p><strong>Evidence synthesis: </strong>Overall, 21 studies were included, with a total of 3084 patients (1157 FEVAR and 1927 OSR). The pooled rate of early mortality following FEVAR was 2.7% (95%CI: 1.6, 4.0; I<sup>2</sup>=27.7%), compared with 3.7% (95%CI: 1.9, 6.0; I<sup>2</sup>=78.1%) after OSR. Comparative studies demonstrated no significant differences in 30-day mortality (odds ratio [OR] 0.79; 95%CI: 0.37, 1.68). A decreased risk of postoperative MACE (OR=0.51; 95%CI: 0.28, 0.95) and bowel ischemia (OR=0.30; 95%CI: 0.11, 0.86) was observed in FEVAR patients although no significant differences were seen regarding AKI (OR=0.62; 95%CI: 0.23, 1.67). Late mortality (OR=1.68; 95%CI: 1.03, 2.74) and reintervention risk (OR=4.17; 95%CI: 2.05, 8.50) were both significantly higher in FEVAR group.</p><p><strong>Conclusions: </strong>FEVAR and OSR showed no statistically significant differences in postoperative mortality in the treatment of patients with AAA with short neck length, despite lower morbidity in the former. Oppositely, FEVAR present with greater mortality and reintervention risk in the midterm. Randomized controlled trials are needed to provide secure recommendations towards preferential use of either technique for juxtarenal AAA repair.</p>\",\"PeriodicalId\":13709,\"journal\":{\"name\":\"International Angiology\",\"volume\":\" \",\"pages\":\"597-605\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Angiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.23736/S0392-9590.24.05283-0\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Angiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S0392-9590.24.05283-0","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/6 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Midterm results after FEVAR and open surgery for infrarenal aortic aneurysms with short proximal necks: systematic review with meta-analysis of comparative studies.
Introduction: This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks.
Evidence acquisition: PubMed, Web of Science and Scopus electronic databases were searched for studies referring to fenestrated endovascular aneurysm repair (FEVAR) or open surgery (OSR) in patients with infrarenal abdominal aortic aneurysms with neck length <15 mm. The primary endpoint of interest was early mortality. Secondary outcomes included major adverse cardiovascular events (MACE), bowel ischemia, acute kidney injury (AKI), late mortality and secondary interventions.
Evidence synthesis: Overall, 21 studies were included, with a total of 3084 patients (1157 FEVAR and 1927 OSR). The pooled rate of early mortality following FEVAR was 2.7% (95%CI: 1.6, 4.0; I2=27.7%), compared with 3.7% (95%CI: 1.9, 6.0; I2=78.1%) after OSR. Comparative studies demonstrated no significant differences in 30-day mortality (odds ratio [OR] 0.79; 95%CI: 0.37, 1.68). A decreased risk of postoperative MACE (OR=0.51; 95%CI: 0.28, 0.95) and bowel ischemia (OR=0.30; 95%CI: 0.11, 0.86) was observed in FEVAR patients although no significant differences were seen regarding AKI (OR=0.62; 95%CI: 0.23, 1.67). Late mortality (OR=1.68; 95%CI: 1.03, 2.74) and reintervention risk (OR=4.17; 95%CI: 2.05, 8.50) were both significantly higher in FEVAR group.
Conclusions: FEVAR and OSR showed no statistically significant differences in postoperative mortality in the treatment of patients with AAA with short neck length, despite lower morbidity in the former. Oppositely, FEVAR present with greater mortality and reintervention risk in the midterm. Randomized controlled trials are needed to provide secure recommendations towards preferential use of either technique for juxtarenal AAA repair.
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).
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
