Outcomes of Fenestrated and Branched Endografts for Partial and Total Endovascular Repair of the Aortic Arch - A Systematic Review and Meta-Analysis

被引:24
作者
Spath, Paolo [1 ,2 ,5 ]
Campana, Federica [1 ]
Tsilimparis, Nikolaos [3 ]
Gallitto, Enrico [1 ,4 ]
Pini, Rodolfo [1 ,4 ]
Faggioli, Gianluca [1 ,4 ]
Caputo, Stefania [1 ]
机构
[1] Univ Bologna, Vasc Surg, DIMEC, Bologna, Italy
[2] AUSL Romagna, Hosp Infermi Rimini, Dept Vasc Surg, Rimini, Italy
[3] Ludwig Maximillian Univ Hosp, Dept Vasc Surg, Munich, Germany
[4] IRCCS Azienda Osped Univ S Orsola, Bologna Metropolitan Vasc Surg Unit, Bologna, Italy
[5] Univ Bologna, Dept Vasc Surg, Vasc Surg, Policlin S Orsola Malpighi, Via Massarenti 9, I-40138 Bologna, Italy
关键词
Aortic arch; Branched endografts; Endovascular repair; Fenestrated endografts; TEVAR; Total endovascular arch repair; STENT-GRAFT; ZONE; ANEURYSMS; DISSECTION; EXPERIENCE; MANAGEMENT; PATHOLOGY; RISK;
D O I
10.1016/j.ejvs.2023.07.048
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to summarise the published results of manufactured F/B-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated with branched configurations. Data Sources: PubMed, Scopus and The Cochrane Library were searched for articles (2018 - 2021) about patients with elective, urgent, or emergency aortic requiring a proximal landing zone in the aortic arch (zone 0 - 1 - 2) and treated by F/B-TEVAR. Review Methods: The systematic review and meta -analysis were performed according to the PRISMA guidelines. Open repair, supra -aortic trunk (SAT) debranching + standard TEVAR, and in situ physician modified and parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality rate. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up. Results: Of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). F-TEVAR, B-TEVAR, and F+B-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 - 0.97; I-2 = 0%; p for heterogeneity (Het) = .77) and the 30 day mortality rate was 6.7% (95% CI 0.05 - 0.09; I-2 = 0%; p Het = .66). No statistical differences were found comparing fenestrated with branched endografts, except for a higher rate of type I - III endoleaks in F-TEVAR (9.8% vs. 2.6%; p = .034). The overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 - 96.4% and 94 - 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively. Conclusion: F/B-TEVAR for the treatment of the aortic arch, according to experience in dedicated centres, now enjoys a satisfactory level of technical success together with a progressively reduced early mortality rate. There are several limitations, and further studies are needed to reach clearer conclusions.
引用
收藏
页码:106 / 116
页数:11
相关论文
共 45 条
[1]   Supra-aortic interventions for endovascular exclusion of the entire aortic arch [J].
Andrasi, Terezia B. ;
Grossmann, Marius ;
Zenker, Dieter ;
Danner, Bernhard C. ;
Schoendube, Friedrich A. .
JOURNAL OF VASCULAR SURGERY, 2017, 66 (01) :281-+
[2]   Parallel grafts and physician modified endografts for endovascular repair of the aortic arch [J].
Atkins, Marvin D. ;
Lumsden, Alan B. .
ANNALS OF CARDIOTHORACIC SURGERY, 2022, 11 (01) :16-25
[3]   Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair [J].
Banno, Hiroshi ;
Mutsuga, Masato ;
Sugimoto, Masayuki ;
Tokuda, Yoshiyuki ;
Kodama, Akio ;
Usui, Akihiko ;
Komori, Kimihiro .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2021, 61 (06) :938-944
[4]  
Amil CLB, 2021, ANN VASC SURG, V75, P29, DOI [10.1016/j.avsg.2021.03.0242021, 10.1016/j.avsg.2021.03.024]
[5]   Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch [J].
Bosse, Come ;
Koelbel, Tilo ;
Mougin, Justine ;
Kratzberg, Jarin ;
Fabre, Dominique ;
Haulon, Stephan .
JOURNAL OF VASCULAR SURGERY, 2020, 72 (03) :805-811
[6]   Case series of aortic arch disease treated with branched stent-graftsfluorescence predicting parathyroid function after thyroid surgery [J].
Clough, R. E. ;
Spear, R. ;
Van Calster, K. ;
Hertault, A. ;
Azzaoui, R. ;
Sobocinski, J. ;
Fabre, D. ;
Haulon, S. .
BRITISH JOURNAL OF SURGERY, 2018, 105 (04) :358-365
[7]   Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS) [J].
Czerny, Martin ;
Schmidli, Jurg ;
Adler, Sabine ;
van den Berg, Jos C. ;
Bertoglio, Luca ;
Carrel, Thierry ;
Chiesa, Roberto ;
Clough, Rachel E. ;
Eberle, Balthasar ;
Etz, Christian ;
Grabenwoeger, Martin ;
Haulon, Stephan ;
Jakob, Heinz ;
Kari, Fabian A. ;
Mestres, Carlos A. ;
Pacini, Davide ;
Resch, Timothy ;
Rylski, Bartosz ;
Schoenhoff, Florian ;
Shrestha, Malakh ;
von Tengg-Kobligk, Hendrik ;
Tsagakis, Konstantinos ;
Wyss, Thomas R. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2019, 57 (02) :165-198
[8]   Management of arch aneurysms with a single-branch thoracic endograft in zone 0 [J].
Dake, Michael D. ;
Bavaria, Joseph E. ;
Singh, Michael J. ;
Oderich, Gustavo ;
Filinger, Mark ;
Fischbein, Michael P. ;
Matsumura, Jon S. ;
Patel, Himanshu J. .
JTCVS TECHNIQUES, 2021, 7 :1-6
[9]   Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease [J].
Fernandez-Alonso, Leopoldo ;
Fernandez Alonso, Sebastian ;
Martinez Aguilar, Esther ;
Santamarta Farina, Estefana ;
Alegret Sole, Jordi ;
Atienza Pascual, Margarita ;
Lopez San Martin, Marina ;
Sanchez Rodriguez, Jose Maria ;
Alvarez, Andres ;
Centeno Vallepuga, Roberto .
ANNALS OF VASCULAR SURGERY, 2020, 69 :360-365
[10]   iTalian RegIstry of doUble inner branch stent graft for arch PatHology (the TRIUmPH Registry) [J].
Ferrer, Ciro ;
Cao, Piergiorgio ;
Coscarella, Carlo ;
Ferri, Michelangelo ;
Lovato, Luigi ;
Camparini, Stefano ;
di Marzo, Luca .
JOURNAL OF VASCULAR SURGERY, 2019, 70 (03) :672-+