Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Author:
Αντωνίου Γεώργιος
Supervisors info:
Χρήστος Λιάπης (επιβλέπων), Ιωάννης Κακίσης, Χρήστος Κλωνάρης
Original Title:
Μετα-ανάλυση των αποτελεσμάτων ενδαγγειακής αποκατάστασης ανευρύσματος κοιλιακής αορτής σε ασθενείς με εχθρική και φιλική ανατομία αυχένα
Translated title:
A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy
Summary:
An increasing number of abdominal aortic aneurysms (AAA) with unfavorable
proximal neck anatomy are treated with standard endograft devices. Skepticism
exists with regard to safety and efficacy of this practice.
Methods
A systematic review of the literature was undertaken to identify all studies
comparing the outcomes of endovascular aneurysm repair (EVAR) in patients with
hostile and friendly infra-renal neck anatomy. Hostile neck conditions were
considered those that were not consistent with the instructions for use of the
endograft devices used in the selected studies. Outcome data were pooled and
combined overall effect sizes were calculated using fixed or random effects
models.
Results
Seven observational studies reporting on 1559 patients (hostile anatomy group,
714 patients; friendly anatomy group, 845 patients) were included. Patients
with hostile anatomy required an increased number of adjunctive procedures to
achieve proximal seal as compared to patients with friendly anatomy (OR =
3.050, 95% CI 1.884-4.938). Even though patients with unfavorable neck anatomy
had an increased risk of developing 30-day morbidity (OR = 2.278, 95% CI
1.025-5.063), no significant differences in the incidence of type I endoleak
and re-intervention rates within 30-days of treatment between the two groups
were identified (OR = 2.467, 95% CI 0.562-10.823; OR = 1.082, 95% CI
0.096-12.186; p = 0.949, respectively). Patients with hostile anatomy had a
four-fold increased risk of developing type I endoleak (OR = 4.563, 95% CI
1.430-14.558) and a nine-fold increased risk of aneurysm-related mortality
within one year of treatment (OR = 9.378, 95% CI 1.595-55.137).
Conclusions
Insufficient high level evidence for or against applying standard EVAR in
patients with hostile neck anatomy exists. Our analysis suggests EVAR is
cautiously used in patients with anatomic neck constraints.
Keywords:
Aneurysm, Abdominal aorta, Endovascular repair, Stent, Hostile anatomy
