Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Author:
Kiparakis Michael
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αχιλλέας Χατζηϊωάννου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Προφυλακτικός εμβολισμός ανευρυσματικού σάκου ή πλάγιων κλάδων στην ενδαγγειακή επιδίορθωση ανευρύσματος: Μετα-ανάλυση και διαδοχική μέθοδος ανάλυσης (TSA) τυχαιοποιημένων μελετών.
Translated title:
Pre-emptive embolization of aneurysm sac or aortic side branches in endovascular aneurysm repair: Meta-analysis and trial sequential analysis of randomized cotrolled trials.
Summary:
Objectives: To investigate outcomes of pre-emptive embolization of the aneurysm sac or aortic side branches in EVAR.
Data sources: Bibliographic sources (MEDLINE, EMBASE, and CENTRAL) were searched using subject headings and free text terms.
Review methods: The review was reported according to PRISMA 2020 with a preregistered protocol. Randomized controlled trials (RCT) comparing EVAR with versus without embolization were included. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI) applying the Mantel-Haenszel method. Continuous outcomes were summarized using mean difference (MD) and 95%CI applying the inverse variance method. The certainty of evidence was appraised with the GRADE framework. Version 2 of the Cochrane tool was used to assess the risk of bias. Trial sequential analysis assumed an alpha=5% and power=80%.
Results: Four RCT reporting a total of 393 patients were included. No significant difference was found in aneurysm-related mortality (RD 0.00, 95%CI -0.03 – 0.03), overall mortality (OR 1.85, 95%CI 0.42 – 8.13), aneurysm rupture (RD 0.00, 95%CI -0.03 – 0.03), type II endoleak-related re-intervention (RD -0.07, 95% CI -0.21 – 0.06), procedure time (MD 20.12, 95% CI -11.54 – 51.77), or fluoroscopy time (MD 11.17, 95% CI -11.22 – 33.56). Patients with pre-emptive embolization had significantly lower odds of developing type II endoleak (OR 0.45, 95% CI 0.26 – 0.78) and sac expansion (OR 0.19, 95% CI 0.07 – 0.52). The risk of bias was high for all outcomes. The certainty of evidence was very low for all outcomes, except for type II endoleak, for which it was low. Trial sequential analysis showed an inconclusive result for overall mortality and type II endoleak-related re-intervention but confirmed the advantage of embolization in reducing type II endoleak and sac expansion.
Conclusions: Limited, low certainty data suggest pre-emptive embolization confers no clinical benefits in EVAR.
Main subject category:
Health Sciences
Keywords:
Endovascular repair, EVAR, Endoleak type II, Pre-emptive, Embolism, Aortic sac, Aortic side branch, Meta-analysis, Abdominal aortic aneurysm
