■II型内漏(T2E),血管内主动脉瘤修复术(EVAR)后最常见的并发症是通过肠系膜下动脉(IMA)的持续逆行血流.T2E治疗围绕供血动脉和/或囊的经动脉和经膜栓塞,结果平庸。这项研究的目的是评估腹腔镜IMA结扎治疗T2E的安全性可行性和有效性。
■我们在Medline上进行了系统的电子研究,Scopus,EMBASE,和Cochrane图书馆根据系统评价和荟萃分析方案(PRISMA)的首选报告项目,针对截至2022年2月发表的文章,描述了腹腔镜IMA结扎治疗T2E。排除描述手辅助或预防性IMA结扎的出版物。利用随机和共同效应模型以及DerSimonian和Laird方法进行了元分析。此外,我们进行了事后权力分析。
■15项研究,包括一个前瞻性病例系列(CS),5例回顾性CS和9例病例报告,包括33例患者(91%为男性)符合纳入标准.诊断时腹主动脉瘤的平均直径为58.8mm。平均运行时间为117.5分钟。纳入研究的平均随访时间为17个月。T2E鉴定的平均报告时间为干预后9.1个月,而在诊断时报告的平均动脉瘤囊直径增加为11.5mm。T2Ea型(T2aE)和b型(T2bE)模式分别为57.6%和42.4%。纳入24例患者的6例CS纳入荟萃分析。合并的技术成功率和术后死亡率为100%(95%CI:93.13-100),(I2=0.0%,p=0.99)(功率=99%)和0.00%(95%CI:0.00-6.87)(I2=0.0%,p=0.99)。合并的再干预和转为开放手术的修复率为15.08%(95%CI:0.79-37.28),(I2=0.0%,p=0.66)(功率=13.6%),和0.69%(95%CI:0.00-14.80)(I2=0.0%,p=0.99)(功率=7.05%)。
■我们证明了IMA结扎治疗T2E的安全性和可行性。由于动力不足的结果值得进一步研究,因此无法得出有关其功效的明确结论。T2E的鉴定和正确分类仍然是影响整个可用治疗范围内的治疗结果和再干预率的障碍。
UNASSIGNED: Type II endoleak (T2E), often generated by persistent retrograde flow through the inferior mesenteric artery (IMA) is the most frequent complication following endovascular aortic aneurysm repair (EVAR). T2E treatment revolves around transarterial and translumbar embolization of the feeding artery and/or sac, with mediocre results. The aim of this study is to assess the safety feasibility and efficacy of laparoscopic IMA ligation for the treatment of T2E.
UNASSIGNED: We conducted a systematic electronic research on Medline, Scopus, EMBASE, and Cochrane Library according to Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA) for articles published up to February 2022, describing laparoscopic IMA ligation for the treatment of T2E. Publications describing hand assisted or prophylactic IMA ligation were excluded. A metanalysis was performed utilizing both the random and common effects model and the DerSimonian and Laird method. Additionally, we carried out a post hoc power analysis.
UNASSIGNED: Fifteen studies, including one prospective case series (CS), five retrospective CS and nine case reports, including 33 patients (91% male) met the inclusion criteria. The mean abdominal aortic aneurysm diameter at the time of diagnosis was 58.8 mm. The mean operational duration was 117.5 minutes. The mean follow-up for the included studies was 17 months. The mean reported time of T2E identification was 9.1 months post-intervention, while the mean reported aneurysmal sac diameter increase at the time of diagnosis was 11.5 mm. T2E type a (T2aE) and type b (T2bE) patterns were 57.6% and 42.4% respectively. Six CS incorporating 24 patients were included in the meta-analysis. The pooled technical success and postoperative mortality rates are 100% (95% CI: 93.13-100), ( I 2 = 0.0%, p = 0.99) (power = 99%) and 0.00% (95% CI: 0.00-6.87) ( I 2 = 0.0%, p = 0.99). The pooled reintervention and conversion to open surgical repair rates are 15.08% (95% CI: 0.79-37.28), ( I 2 = 0.0%, p = 0.66) (power = 13.6%), and 0.69% (95% CI: 0.00-14.80) ( I 2 = 0.0%, p = 0.99) (power = 7.05%) respectively.
UNASSIGNED: We demonstrated the safety and feasibility of IMA ligation for the treatment of T2E. Definitive conclusions about its efficacy cannot be drawn due to underpowered results warrantying further research. Identification and proper classification of T2E remain an obstacle affecting treatment outcomes and reintervention rates throughout the entire spectrum of available treatments.