Therapeutic Options and Outcomes in Midaortic Syndrome: A Systematic Review and Meta-analysis

被引:4
|
作者
Cortenbach, Kimberley R. G. [1 ]
Yosofi, Bahram [2 ]
Rodwell, Laura [3 ]
Meek, Jelena [1 ]
Patel, Ritesh [4 ]
Prakash, Siddharth K. [5 ]
Riksen, Niels P. [6 ]
Jenniskens, Sjoerd F. M. [7 ]
Dirven, Mark [8 ]
DeRuiter, Marco C. [9 ]
van Kimmenade, Roland R. J. [2 ,10 ]
机构
[1] Radboud Univ Nijmegen, Radboud Inst Mol Life Sci, Dept Tumour Immunol, Med Ctr, Nijmegen, Netherlands
[2] Radboud Univ Nijmegen, Dept Cardiol, Med Ctr, Nijmegen, Netherlands
[3] Radboud Univ Nijmegen, Med Ctr, Dept Hlth Evidence, Nijmegen, Netherlands
[4] Univ S Florida, Dept Internal Med, Div Cardiol, Morsani Coll Med, Tampa, FL USA
[5] John Ritter Res Program Aort & Vasc Dis, Dept Internal Med, Div Cardiol, Houston, TX USA
[6] Radboud Univ Nijmegen, Radboud Ctr Infect Dis, Dept Internal Med, Med Ctr, Nijmegen, Netherlands
[7] Radboud Univ Nijmegen, Dept Med Imaging, Med Ctr, Nijmegen, Netherlands
[8] Radboud Univ Nijmegen, Dept Surg, Div Vasc & Transplant Surg, Med Ctr, Nijmegen, Netherlands
[9] Leiden Univ, Dept Anat & Embryol, Med Ctr, Leiden, Netherlands
[10] Dept Cardiol, Route 616,POB 9101, NL-6500 HB Nijmegen, Netherlands
关键词
Abdominal coarctation; Endovascular therapy; Meta-analysis; Midaortic syndrome; Surgery; Systematic review;
D O I
10.1016/j.ejvs.2022.10.017
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Midaortic syndrome (MAS) is narrowing of the distal thoracic and or abdominal aorta with congenital, inflammatory, or idiopathic aetiology. If left untreated, the prognosis is poor due to hypertensive complications. Follow up data after treatment are sparse, contrary to aortic coarctation. This study aimed to investigate hypertension during follow up after medical, endovascular, and surgical therapy in juveniles and adults.Data sources: A meta-analysis of case series and reports was performed, focusing on the incidence of hypertension during the follow up of juvenile (i.e., age 0-17 years) and adult MAS patients after medical, endovascular, or surgical therapy.Review methods: Search queries were performed in PubMed, Embase, and Web of Science, and eligible articles underwent quality control. Descriptive statistics were reported based on available data, and individual patient data meta-analyses were performed using a one stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed.Results: The number of juveniles and adults who underwent endovascular therapy (33.7% vs. 27.3%; p = .42) and surgery (52.2% vs. 58.0%; p = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow up of 23 months (juveniles) and 18 months (adults), respectively. More hypertension was found compared with surgery in juveniles after endovascular therapy (38.1% vs. 10.8%; p = .020). Meta-analysis also demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared with endovascular therapy or medication.Conclusion: This review and meta-analysis investigated therapeutic options for MAS in juveniles and adults. It found that complications and hypertension during follow up were more common in juveniles after endovascular treatment, whereas surgery in adults was associated with more hypertension.
引用
收藏
页码:120 / 130
页数:11
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