Abstract：
BACKGROUND: We investigated the early and midterm efficacy and safety of covered endovascular reconstruction of the aortic bifurcation (CERAB) in the treatment of aortoiliac disease (AID).
METHODS: A systematic search on PubMed, Scopus, and Web of Science for articles published by August 2023 was performed. The primary end points were primary patency and secondary patency.
RESULTS: Eleven retrospective case series, involving 579 patients, were incorporated in the review with 88.9% of the included lesions being categorized as Trans-Atlantic Inter-Society Consensus (TASC) C or D. The pooled primary patency estimates at 12, 24 and 36 months were 94.4% (95% confidence interval [CI], 89.4-99.7), 84.4% (95% CI, 72.3-98.5) and 83.8% (95% CI, 71.4-98.3) respectively. The mean primary patency time, representing the period during which individuals remained event-free, was 51.9 months (95% CI, 43.6-55.4). The pooled 36 months primary patency for studies with a predominantly claudicant patient population (>75% of patients) was 89.4% (95% CI, 78.5-100.0), compared with 71.5% (95% CI, 45.6-100.0) for studies with a mixed population (50% of patients). The pooled 36 months primary patency for studies with a predominantly TASC D patient population (>82% of patients) was 70.4% (95% CI, 46.4-100.0) compared with 91.0% (95% CI, 79.1-100.0) for studies with a more homogenous cohort. The pooled secondary patency estimates at 12, 24, and 36 months were 98.6% (95% CI, 96.2-100.0), 97% (95% CI, 93.1-100.0), and 97% (95% CI, 93.1-100.0), respectively. The pooled technical success, 30-day mortality and 30-day systemic complications estimates were 95.9% (95% CI, 93.7- 97.4), 1.9% (95% CI, 1.0-3.5), and 6.4% (95% CI, 4.4-9.1), respectively. The pooled intraoperative and postoperative 30-day CERAB-related complications estimates were 7.3% (95% CI, 2.0-23.0) and 4.2% (95% CI, 0.7-21.0), respectively. The pooled major amputation and target lesion reinterventions by the end of follow-up were 1.9% (95% CI, 1.0-3.4) and 13.9% (95% CI, 9.9-19.2), respectively. The pooled access site complication estimate was 11.7% (95% CI, 5.9-21.7).
CONCLUSIONS: Although this review has showcased the safety and feasibility of the CERAB technique in treating AID, it has also highlighted the necessity for a close and prolonged follow-up period extending beyond 1 year. Moreover, the favorable secondary patency estimates predominantly attained via endovascular reinterventions emphasize a potentially advantageous characteristic of the CERAB technique, particularly valuable when addressing late-stage AID disease or anatomically complex lesions.
METHODS: A systematic search on PubMed, Scopus, and Web of Science for articles published by August 2023 was performed. The primary end points were primary patency and secondary patency.
RESULTS: Eleven retrospective case series, involving 579 patients, were incorporated in the review with 88.9% of the included lesions being categorized as Trans-Atlantic Inter-Society Consensus (TASC) C or D. The pooled primary patency estimates at 12, 24 and 36 months were 94.4% (95% confidence interval [CI], 89.4-99.7), 84.4% (95% CI, 72.3-98.5) and 83.8% (95% CI, 71.4-98.3) respectively. The mean primary patency time, representing the period during which individuals remained event-free, was 51.9 months (95% CI, 43.6-55.4). The pooled 36 months primary patency for studies with a predominantly claudicant patient population (>75% of patients) was 89.4% (95% CI, 78.5-100.0), compared with 71.5% (95% CI, 45.6-100.0) for studies with a mixed population (50% of patients). The pooled 36 months primary patency for studies with a predominantly TASC D patient population (>82% of patients) was 70.4% (95% CI, 46.4-100.0) compared with 91.0% (95% CI, 79.1-100.0) for studies with a more homogenous cohort. The pooled secondary patency estimates at 12, 24, and 36 months were 98.6% (95% CI, 96.2-100.0), 97% (95% CI, 93.1-100.0), and 97% (95% CI, 93.1-100.0), respectively. The pooled technical success, 30-day mortality and 30-day systemic complications estimates were 95.9% (95% CI, 93.7- 97.4), 1.9% (95% CI, 1.0-3.5), and 6.4% (95% CI, 4.4-9.1), respectively. The pooled intraoperative and postoperative 30-day CERAB-related complications estimates were 7.3% (95% CI, 2.0-23.0) and 4.2% (95% CI, 0.7-21.0), respectively. The pooled major amputation and target lesion reinterventions by the end of follow-up were 1.9% (95% CI, 1.0-3.4) and 13.9% (95% CI, 9.9-19.2), respectively. The pooled access site complication estimate was 11.7% (95% CI, 5.9-21.7).
CONCLUSIONS: Although this review has showcased the safety and feasibility of the CERAB technique in treating AID, it has also highlighted the necessity for a close and prolonged follow-up period extending beyond 1 year. Moreover, the favorable secondary patency estimates predominantly attained via endovascular reinterventions emphasize a potentially advantageous characteristic of the CERAB technique, particularly valuable when addressing late-stage AID disease or anatomically complex lesions.
摘要：
背景：我们研究了覆盖的主动脉分叉腔内重建（CERAB）治疗主髂动脉疾病（AID）的早中期疗效和安全性。
方法：在PubMed上进行系统搜索，Scopus和Webofscience为2023年8月发表的文章进行了表演。主要终点是原发性通畅和继发性通畅。
结果：11个回顾性病例系列，涉及579名患者,纳入审查，其中88.9％的病变被归类为跨大西洋社会共识文件（TASC）C或D。24个月和36个月为94.4%(95%CI：89.4-99.7)，84.4%（95%CI：72.3-98.5）和83.8%（95%CI：71.4-98.3）。平均初级通畅时间，代表个人保持无事件状态的时期，为51.9个月（95%CI：43.6-55.4）。合并36个月的主要通畅性患者（>75％的患者）为89.4％（95％CI：78.5-100），与混合人群（50％的患者）的研究相比，71.5％（95％CI：45.6-100.0）。对于主要为TASCD患者人群（>82％的患者）的研究，合并的36个月主要通畅率为70.4％（95％CI：46.4-100.0），而对于具有更同质队列的研究为91.0％（95％CI：79.1-100）。汇总的二级通畅度估计为12点，24个月和36个月为98.6%（95%CI：96.2-100），97%（95%CI：93.1-100）和97%（95%CI：93.1-100）。汇集的技术成功，30天死亡率和30天全身并发症估计值为95.9%(95%CI:93.7-97.4),1.9%（95%CI：1.0-3.5）和6.4%（95%CI：4.4-9.1）。合并的术中和术后30天CERAB相关并发症估计值分别为7.3％（95％CI：2.0-23.0）和4.2％（95％CI：0.7-21.0）。随访结束时合并的主要截肢和目标病变再干预分别为1.9％（95％CI：1.0-3.4）和13.9％（95％CI：9.9-19.2）。合并的进入部位并发症估计值为11.7％（95％CI：5.9-21.7）。
结论：虽然本综述显示了CERAB技术治疗AID的安全性和可行性，它还强调了持续一年以上的密切和长期随访的必要性。此外，主要通过血管内再介入术获得的有利次要通畅度评估强调了CERAB技术的潜在有利特征,在解决晚期AID疾病或解剖学上复杂的病变时特别有价值。
方法：在PubMed上进行系统搜索，Scopus和Webofscience为2023年8月发表的文章进行了表演。主要终点是原发性通畅和继发性通畅。
结果：11个回顾性病例系列，涉及579名患者,纳入审查，其中88.9％的病变被归类为跨大西洋社会共识文件（TASC）C或D。24个月和36个月为94.4%(95%CI：89.4-99.7)，84.4%（95%CI：72.3-98.5）和83.8%（95%CI：71.4-98.3）。平均初级通畅时间，代表个人保持无事件状态的时期，为51.9个月（95%CI：43.6-55.4）。合并36个月的主要通畅性患者（>75％的患者）为89.4％（95％CI：78.5-100），与混合人群（50％的患者）的研究相比，71.5％（95％CI：45.6-100.0）。对于主要为TASCD患者人群（>82％的患者）的研究，合并的36个月主要通畅率为70.4％（95％CI：46.4-100.0），而对于具有更同质队列的研究为91.0％（95％CI：79.1-100）。汇总的二级通畅度估计为12点，24个月和36个月为98.6%（95%CI：96.2-100），97%（95%CI：93.1-100）和97%（95%CI：93.1-100）。汇集的技术成功，30天死亡率和30天全身并发症估计值为95.9%(95%CI:93.7-97.4),1.9%（95%CI：1.0-3.5）和6.4%（95%CI：4.4-9.1）。合并的术中和术后30天CERAB相关并发症估计值分别为7.3％（95％CI：2.0-23.0）和4.2％（95％CI：0.7-21.0）。随访结束时合并的主要截肢和目标病变再干预分别为1.9％（95％CI：1.0-3.4）和13.9％（95％CI：9.9-19.2）。合并的进入部位并发症估计值为11.7％（95％CI：5.9-21.7）。
结论：虽然本综述显示了CERAB技术治疗AID的安全性和可行性，它还强调了持续一年以上的密切和长期随访的必要性。此外，主要通过血管内再介入术获得的有利次要通畅度评估强调了CERAB技术的潜在有利特征,在解决晚期AID疾病或解剖学上复杂的病变时特别有价值。
