Τίτλος:
Endovascular Aneurysm Repair with Bifurcated Stent Grafts in Patients
with Narrow Versus Regular Aortic Bifurcation: Systematic Review and
Meta-analysis of Comparative Studies
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Narrow aortic bifurcation (NAB) is considered as a risk
factor for endograft limb thrombosis. The purpose of the study was to
investigate the effect of narrow aortic bifurcation on outcomes of
elective endovascular aneurysm repair (EVAR).
Methods: A systematic review that conformed to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines was performed.
We searched electronic bibliographic databases using a combination of
controlled vocabulary (thesaurus) and free-text terms to identify
relevant studies comparing outcomes of EVAR in patients with NAB versus
those with regular aortic bifurcation. Pooled estimates of dichotomous
outcomes were calculated using odds ratio (OR) and those of continuous
outcomes using mean difference and 95% confidence interval (CI). To
account for expected heterogeneity, the random-effects model was applied
for statistical analysis.
Results: Six observational studies were included, reporting a total of
2,673 patients (412 with NAR and 2,261 with friendly anatomy).
Perioperative mortality was similar between the groups (OR 1.14, 95% CI
0.30-4.34, P = 0.85, I-2 = 0%). Limb stenosis and kinking requiring
additional intraoperative procedures was significantly more common among
patients with NAB (OR 3.02, 95% CI 2.16-4.22, P < 0.00001, I-2 = 0%).
Nevertheless, 30-day reintervention rate was similar between the groups,
as was the rate of limb occlusion during follow-up.
Conclusions: Available evidence suggests that at the expense of
significantly more intraoperative additional procedures, EVAR with
bifurcated devices can be safely performed in patients with NAB.
Συγγραφείς:
Galanakis, Nikolaos
Kontopodis, Nikolaos
Charalambous, Stavros
and Palioudakis, Stefanos
Kakisis, Ioannis
Geroulakos, George
and Tsetis, Dimitrios
Ioannou, Christos V.
Περιοδικό:
Annals of Vascular Surgery
Εκδότης:
ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
DOI:
10.1016/j.avsg.2020.11.022
