Angelos Karelis, Tilo Kölbel, Tara Mastracci, Athanasios Katsargyris, Stephan Haulon, Nikolaos Tsilimparis, George A Antoniou
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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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Branched Endovascular Aortic Repair with Inner and Outer Branches: A Systematic Review and Meta-analysis.\",\"authors\":\"Angelos Karelis, Tilo Kölbel, Tara Mastracci, Athanasios Katsargyris, Stephan Haulon, Nikolaos Tsilimparis, George A Antoniou\",\"doi\":\"10.1016/j.ejvs.2025.03.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This systematic review aimed to assess clinical outcomes of branched endovascular aortic repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR).</p><p><strong>Data sources: </strong>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.</p><p><strong>Review methods: </strong>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.</p><p><strong>Results: </strong>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. 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引用次数: 0
摘要
目的：本系统综述旨在评价血管内分支（iBEVAR）和内/外分支（oBEVAR）血管内主动脉分支修复（BEVAR）的临床效果。数据来源：使用电子书目数据库MEDLINE、Embase、Scopus、Web of Science和Cochrane Library进行系统文献综述，截止到2024年5月。评价方法：按照系统评价和荟萃分析（PRISMA）指南的首选报告项目设计和报告。符合条件的研究报告了死亡、技术失败、原发性靶血管通畅（TVs）、TV相关并发症、分支相关再干预和脊髓缺血（SCI）。使用ROBINS-I工具评估偏倚风险。结果：纳入27项观察性研究，共报道1 780例BEVAR和6 633例tv治疗。iBEVAR选择性治疗386例（84.3%），紧急治疗72例（15.6%），而oBEVAR分别为845例（63.2%）和491例（36.7%）。iBEVAR 30天死亡率的汇总估计为4.9%(95%可信区间[CI] 2.9 - 8.2%)， oBEVAR为7.6%（95%可信区间[CI] 4.9 - 11.7%）。iBEVAR的总死亡率为13.8% (95% CI 9.7 - 19.1%)，而oBEVAR的总死亡率为15.4% （95% CI 10.6 - 21.9%）。iBEVAR的SCI发生率为6.5% (95% CI 4.2 - 10.0%)，而oBEVAR的SCI发生率为12.9% （95% CI 9.6 - 17.1%）。iBEVAR （97.3%, 95% CI 94.8 - 98.6%）和oBEVAR （97.6%, 95% CI 95.3 - 98.7%）的原发性电视通畅率相似。iBEVAR组靶血管相关并发症发生率为2.9% (95% CI 2.0 - 4.1%)，而oBEVAR组为3.9% （95% CI 2.7 - 5.6%）。iBEVAR的技术失败率为4.1% (95% CI 2.4 - 6.9%)，而oBEVAR的技术失败率为5.7% （95% CI 3.5 - 9.1%）。所有结果的评估、发展和评价（GRADE）确定性都很低或非常低。结论：内支和内/外支血管内动脉瘤修复已被用于选择性和紧急病例，以及各种解剖结构，两种设计均显示出令人满意的临床结果。
Branched Endovascular Aortic Repair with Inner and Outer Branches: A Systematic Review and Meta-analysis.
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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