{"title":"非复杂腹主动脉瘤的血管内与开放修复：系统回顾和荟萃分析。","authors":"En Qing Lim, Gavin O'Brien","doi":"10.1016/j.avsg.2025.09.044","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The risk of rupture and mortality associated with abdominal aortic aneurysms (AAA) necessitates timely surgical intervention. Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the two primary surgical techniques, frequently compared for efficacy and safety. EVAR is less invasive and reduces perioperative mortality but carries a higher risk of long-term complications. This meta-analysis evaluates short- and long-term outcomes of EVAR and OSR in infrarenal non-complex AAA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Primary outcomes included perioperative mortality, long-term all-cause mortality, and aneurysm-related mortality. Secondary outcomes assessed reintervention, complication and limb graft occlusion (LGO) rates. Random-effects model were used for statistical analysis.</p><p><strong>Results: </strong>Compared with OSR, EVAR significantly reduced perioperative mortality (OR = 0.45; 95% CI: 0.27-0.75; p = 0.002; I<sup>2</sup> = 63%). At the longest follow-up (6-15 years), all-cause mortality did not differ significantly (OR = 1.06; 95% CI: 0.97-1.17; p = 0.22). Aneurysm-related mortality showed a non-significant trend toward higher rates after EVAR (OR = 1.17; 95% CI: 0.88-1.56; p = 0.29). Secondary interventions were significantly more frequent after EVAR (OR = 2.27; 95% CI: 1.32-3.93; p = 0.003). Pooled analysis demonstrated over fourfold increased odds of LGO with EVAR compared to OSR (OR = 4.07; 95% CI: 2.15-7.71; p < 0.0001). Endoleaks were the most common EVAR-related complication, with higher rates of Type I endoleak and LGO for Zenith Flex versus Endurant II in the Enzen Trial.</p><p><strong>Conclusions: </strong>EVAR confers a perioperative survival benefit over OSR but does not improve long-term all-cause mortality. Late aneurysm-related deaths, reinterventions, and LGO are more frequent after EVAR, emphasizing the need for lifelong surveillance and careful patient selection.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endovascular Versus Open Repair for Non-Complex Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis.\",\"authors\":\"En Qing Lim, Gavin O'Brien\",\"doi\":\"10.1016/j.avsg.2025.09.044\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The risk of rupture and mortality associated with abdominal aortic aneurysms (AAA) necessitates timely surgical intervention. Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the two primary surgical techniques, frequently compared for efficacy and safety. EVAR is less invasive and reduces perioperative mortality but carries a higher risk of long-term complications. This meta-analysis evaluates short- and long-term outcomes of EVAR and OSR in infrarenal non-complex AAA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Primary outcomes included perioperative mortality, long-term all-cause mortality, and aneurysm-related mortality. Secondary outcomes assessed reintervention, complication and limb graft occlusion (LGO) rates. Random-effects model were used for statistical analysis.</p><p><strong>Results: </strong>Compared with OSR, EVAR significantly reduced perioperative mortality (OR = 0.45; 95% CI: 0.27-0.75; p = 0.002; I<sup>2</sup> = 63%). At the longest follow-up (6-15 years), all-cause mortality did not differ significantly (OR = 1.06; 95% CI: 0.97-1.17; p = 0.22). Aneurysm-related mortality showed a non-significant trend toward higher rates after EVAR (OR = 1.17; 95% CI: 0.88-1.56; p = 0.29). Secondary interventions were significantly more frequent after EVAR (OR = 2.27; 95% CI: 1.32-3.93; p = 0.003). Pooled analysis demonstrated over fourfold increased odds of LGO with EVAR compared to OSR (OR = 4.07; 95% CI: 2.15-7.71; p < 0.0001). Endoleaks were the most common EVAR-related complication, with higher rates of Type I endoleak and LGO for Zenith Flex versus Endurant II in the Enzen Trial.</p><p><strong>Conclusions: </strong>EVAR confers a perioperative survival benefit over OSR but does not improve long-term all-cause mortality. Late aneurysm-related deaths, reinterventions, and LGO are more frequent after EVAR, emphasizing the need for lifelong surveillance and careful patient selection.</p>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-10-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.avsg.2025.09.044\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.09.044","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
背景：腹主动脉瘤（AAA）的破裂和死亡风险需要及时的手术干预。开放手术修复（OSR）和血管内动脉瘤修复（EVAR）是两种主要的手术技术，经常比较其疗效和安全性。EVAR侵入性较小，可降低围手术期死亡率，但具有较高的长期并发症风险。本荟萃分析评估了肾下非复杂aaa患者EVAR和OSR的短期和长期结果。方法：根据PRISMA指南进行系统回顾和荟萃分析。主要结局包括围手术期死亡率、长期全因死亡率和动脉瘤相关死亡率。次要结果评估再干预、并发症和肢体移植闭塞（LGO）率。采用随机效应模型进行统计分析。结果：与OSR相比，EVAR显著降低围手术期死亡率（OR = 0.45; 95% CI: 0.27-0.75; p = 0.002; I2 = 63%）。在最长随访期（6-15年），全因死亡率无显著差异（OR = 1.06; 95% CI: 0.97-1.17; p = 0.22）。动脉瘤相关死亡率在EVAR后呈无显著性升高趋势（OR = 1.17; 95% CI: 0.88-1.56; p = 0.29）。EVAR后的二次干预明显更频繁（OR = 2.27; 95% CI: 1.32-3.93; p = 0.003）。合并分析显示，与OSR相比，LGO合并EVAR的几率增加了4倍以上（OR = 4.07; 95% CI: 2.15-7.71; p < 0.0001）。endoolaks是最常见的evar相关并发症，在Enzen试验中，Zenith Flex与enduurant II相比，I型endoolaks和LGO的发生率更高。结论：EVAR比OSR更有利于围手术期生存，但不能改善长期全因死亡率。晚期动脉瘤相关死亡、再干预和LGO在EVAR后更为常见，这强调了终身监测和仔细选择患者的必要性。
Endovascular Versus Open Repair for Non-Complex Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis.
Background: The risk of rupture and mortality associated with abdominal aortic aneurysms (AAA) necessitates timely surgical intervention. Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the two primary surgical techniques, frequently compared for efficacy and safety. EVAR is less invasive and reduces perioperative mortality but carries a higher risk of long-term complications. This meta-analysis evaluates short- and long-term outcomes of EVAR and OSR in infrarenal non-complex AAA.
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Primary outcomes included perioperative mortality, long-term all-cause mortality, and aneurysm-related mortality. Secondary outcomes assessed reintervention, complication and limb graft occlusion (LGO) rates. Random-effects model were used for statistical analysis.
Results: Compared with OSR, EVAR significantly reduced perioperative mortality (OR = 0.45; 95% CI: 0.27-0.75; p = 0.002; I2 = 63%). At the longest follow-up (6-15 years), all-cause mortality did not differ significantly (OR = 1.06; 95% CI: 0.97-1.17; p = 0.22). Aneurysm-related mortality showed a non-significant trend toward higher rates after EVAR (OR = 1.17; 95% CI: 0.88-1.56; p = 0.29). Secondary interventions were significantly more frequent after EVAR (OR = 2.27; 95% CI: 1.32-3.93; p = 0.003). Pooled analysis demonstrated over fourfold increased odds of LGO with EVAR compared to OSR (OR = 4.07; 95% CI: 2.15-7.71; p < 0.0001). Endoleaks were the most common EVAR-related complication, with higher rates of Type I endoleak and LGO for Zenith Flex versus Endurant II in the Enzen Trial.
Conclusions: EVAR confers a perioperative survival benefit over OSR but does not improve long-term all-cause mortality. Late aneurysm-related deaths, reinterventions, and LGO are more frequent after EVAR, emphasizing the need for lifelong surveillance and careful patient selection.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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