■开窗式血管内动脉瘤修复术(FEVAR)和烟囱式血管内动脉瘤修复术(ChEVAR)治疗近肾主动脉瘤(JAAs)的疗效比较尚不清楚。我们的目标是识别和分析当前的证据体系,比较两种技术对JAA的有效性。
■我们进行了系统评价和荟萃分析,比较了FEVAR和ChEVAR对JAA修复的有效性。我们搜索了MEDLINE,EMBASE,和Cochrane注册自1990年1月1日起进行对照试验,用于评估FEVAR和ChEVAR用于JAA修复的结果的随机和非随机研究。筛选,数据提取,偏见风险评估,和等级(建议的等级,评估,发展,和评估)证据的确定性一式两份。在可能的情况下对数据进行统计汇总。
■纳入9项回顾性队列研究,比较FEVAR和ChEVAR治疗近肾动脉瘤的疗效。荟萃分析的FEVAR和ChEVAR臂由726名参与者和518名参与者组成,分别。每个手臂有598名(86.8%)和332名(81.6%)男性。ChEVAR臂的平均直径较大(59mmvs52.5mm)。两种技术术后30天死亡率相似,3.38%(8/237)与3.52%(8/227),急性肾损伤,16.76%(31/185)与17.31%(18/104),和主要不良心脏事件,7.30%(46/630)与6.60%(22/333)。荟萃分析支持将FEVAR用于大多数结果,具有技术成功的显着优势(优势比[OR]:3.24,95%CI:1.24-8.42)和避免1型内漏(OR:5.76,95%CI:1.94-17.08),但对脊髓缺血不利(OR:10.21,95%CI:1.21-86.11),事件数量很少。大多数结果的证据质量是“中等”的。
■两种血管内技术均具有良好的安全性。证据不支持FEVAR或ChEVAR对JAA的优越性。
虽然缺乏平衡阻碍了开腹与腔内修复术治疗近肾主动脉瘤的随机试验的设计,对血管内修复术的耐久性的关注凸显了需要更有力的证据来证明血管内技术的比较疗效.这篇综述对大型观察性研究的最新数据进行了荟萃分析和证据评估,比较了开窗和烟囱技术,使用全面的结果集。由于每个研究组参与者基线风险的差异,任何一种干预措施的优势都无法确定。然而,数据表明,两种技术都是安全的,适合在指示时使用。
UNASSIGNED: Comparative effectiveness of fenestrated endovascular aneurysm repair (FEVAR) and chimney graft endovascular aneurysm repair (ChEVAR) for juxtarenal aortic aneurysms (JAAs) remains unclear. Our objective was to identify and analyze the current body of evidence comparing the effectiveness of both techniques for JAA.
UNASSIGNED: We performed a systematic
review and meta-analysis comparing the effectiveness of FEVAR and ChEVAR for JAA repair. We searched MEDLINE, EMBASE, and Cochrane Register for Controlled Trials from January 1, 1990, for randomized and non-randomized studies assessing outcomes of FEVAR and ChEVAR for JAA repair. Screening, data extraction, risk of bias assessment, and GRADE (Grading of Recommendations, Assessments, Development, and Evaluations) certainty of evidence were performed in duplicate. Data were pooled statistically where possible.
UNASSIGNED: Nine retrospective cohort studies comparing the use of FEVAR and ChEVAR for juxtarenal aneurysm were included for meta-analysis. The FEVAR and ChEVAR arms of the meta-analysis consisted of 726 participants and 518 participants, respectively. There were 598 (86.8%) and 332 (81.6%) men in each arm. The mean diameter was larger in the ChEVAR arm (59 mm vs 52.5 mm). Both techniques had similar rates of postoperative 30-day mortality, 3.38% (8/237) versus 3.52% (8/227), acute kidney injury, 16.76% (31/185) versus 17.31% (18/104), and major adverse cardiac events, 7.30% (46/630) versus 6.60% (22/333). The meta-analysis supported the use of FEVAR for most outcomes, with significant advantage for technical success (odds ratio [OR]: 3.24, 95% CI: 1.24-8.42) and avoidance of type 1 endoleak (OR: 5.76, 95% CI: 1.94-17.08), but a disadvantage for spinal cord ischemia (OR: 10.21, 95% CI: 1.21-86.11), which had a very low number of events. The quality of evidence was \"moderate\" for most outcomes.
UNASSIGNED: Both endovascular techniques had good safety profiles. The evidence does not support superiority of either FEVAR or ChEVAR for JAA.
UNASSIGNED: While lack of equipoise has hampered the design of randomised trials of open versus endovascular repair of juxtarenal aortic aneurysms, concern about the durability of endovascular repair highlights the need for stronger evidence of the comparative efficacy of endovascular techniques. This
review performed meta-analysis and evidence appraisal of recent data from large observational studies comparing fenestrated and chimney techniques, using a comprehensive outcome set. Superiority of either intervention could not be established due to differences in participants\' baseline risk in each study arm. However, data suggests that both techniques are safe and suitable for use when indicated.