Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

Antoniou, George Α.; Juszczak, Maciej; Antoniou, Stavros A.; Katsargyris, Αthanasios; Haulon, Stéphan

doi:10.1016/j.ejvs.2020.10.010

Cited by 47 publications

(20 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Verschiedene systematische Reviews und Metaanalysen haben in der Vergangenheit versucht, die Datenlage zu objektivieren. Je nach Arbeit werden hier aus 8-71 Studien bis zu 8000 TAAA-Patienten respektive der beiden Verfahren Open Repair (OR) oder Fenestrated/branched endovascular aortic Repair (f/bEVAR) verglichen [19,20,21]. Dabei finden sich in allen Studien in den endovaskulären Gruppen Patienten mit höherem Alter und mehr Komorbiditäten im Vergleich.…”

Section: Einordnung Beider Verfahren Im Literarischen Kontextunclassified

“…9 %) zugunsten f/bEVAR, aber auch eine nicht signifikante Reduktion des Gesamtüberlebens (ca. 60-70 % nach 3-5 Jahren) [19,20]. Demgegenüber steht eine signifikant erhöhte Re-Interventionsrate (ca.…”

Section: Einordnung Beider Verfahren Im Literarischen Kontextunclassified

“…Demgegenüber steht eine signifikant erhöhte Re-Interventionsrate (ca. 20 %) bei endovaskulärer Versorgung [19]. Bezüglich der Rate spinaler Ischämien mit permanenter Beeinträchtigung (ca.…”

Section: Einordnung Beider Verfahren Im Literarischen Kontextunclassified

See 2 more Smart Citations

Offener thorakaler und thorakoabdominaler Aortenersatz vs. f/b(T)EVAR – komplementär oder kompetitiv?

et al. 2021

View full text Add to dashboard Cite

ZusammenfassungDer offen-chirurgische thorakale und thorakoabdominelle Aortenersatz (open repair, OR) bei Aneurysmen oder Dissektionen hat in der aktuellen Versorgungsrealität im Vergleich zur endovaskulären Versorgung mit einfachen und speziellen Stentprothesen (fenestrated/branched [thoracic] endovascular aortic repair, f/b[T]EVAR) eine deutlich untergeordnete Rolle. Zudem besteht die Notwendigkeit einer hohen technischen Expertise und eines umfangreichen operativen Settings, um ein OR sicher anbieten zu können.Zu Reduktion der spezifischen Komplikationen, wie z. B. perioperative Mortalität, permanente Dialysepflichtigkeit, spinale Ischämie, Schlaganfall oder Mesenterialischämie, ist ein hohes Maß an intraoperativer Protektion, z. B. mittels Liquordrainage, Point-of-Care-Gerinnungstherapie, distaler oder selektiver Aortenperfusion im Sinne eines temporären Linksherzbypasses und sequenziellem Clamping der Aorta erforderlich. Trotz der Dominanz der endovaskulären Therapie ist diese Expertise aber weiterhin nötig, um spezifische Indikationen, wie beispielsweise junges Patientenalter oder Bindegewebserkrankungen bzw. Protheseninfektionen, sicher versorgen zu können. Zusätzlich ist nicht jedes Aneurysma oder jede Dissektion anatomisch langfristig sicher mit einer endovaskulären Behandlung zu therapieren.Die aktuelle Evidenzlage sieht einen geringen, meist nicht statistisch signifikanten Vorteil von TEVAR und f/bEVAR versus OR bei den wichtigsten kurz- und mittelfristigen Ergebnisparametern, bei deutlich geringerer Invasivität und verkürzter Krankenhausliegedauer. Im langfristigen Verlauf sind die Ergebnisse bezüglich Gesamtüberleben und Re-Interventionsraten bzw. sekundärer Komplikationen bei OR deutlich besser.Der offene thorakoabdominelle Aortenersatz ist also nach wie vor mehr als ein exklusives Hobby, sondern vielmehr eine absolute Notwendigkeit im Gesamtspektrum der aortalen Chirurgie, dessen Bedeutung in den nächsten Jahren mutmaßlich wieder zunimmt.

show abstract

Section: Einordnung Beider Verfahren Im Literarischen Kontextunclassified

See 1 more Smart Citation

Offener thorakaler und thorakoabdominaler Aortenersatz vs. f/b(T)EVAR – komplementär oder kompetitiv?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Fenestrated endovascular aneurysm repair (FEVAR) is a well-established treatment modality for patients with a juxtarenal abdominal aortic aneurysm (JAAA) [ 1 , 2 ]. The custom-made fenestrated stent graft (FSG) enables juxta- and suprarenal sealing while maintaining blood flow to the visceral arteries through the fenestrations.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair

Riet

Schuurmann

Verhoeven

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

In balloon-expandable covered stent (BECS) associated complications after fenestrated endovascular aneurysm repair (FEVAR), geometric analysis may determine the cause of failure and influence reintervention strategies. This study retrospectively classifies BECS-associated complications based on computed tomographic angiography (CTA) applied geometric analysis. BECS-associated complications of FEVAR-patients treated in two large vascular centers between 2012 and 2021 were included. The post-FEVAR CTA scans of complicated Advanta V12 BECSs were analyzed geometrically and complications were classified according to its location in the BECS. BECS fractures were classified according to an existing classification system. In 279 FEVAR-patients, 34 out of the 683 included Advanta V12 BECS (5%) presented with a complication. Two Advanta V12 complications occurred during the FEVAR procedure and 32 occurred during follow-up of which five post-FEVAR CTA scans were missing or not suitable for analysis. In the remaining 27 BECSs complications were classified as (endoleaks (n = 8), stenoses (n = 4), occlusions (n = 6), fractures (n = 3), and a combination of complications (n = 6)). All BECSs associated complications after FEVAR with available follow up CTA scans could be classified. Geometric analysis of BECS failure post-FEVAR can help to plan the reintervention strategy.

show abstract

“…Due to limited high-level evidence and in an effort to limit confounding and selection bias, clinicians have utilised advanced statistical methods using propensity-matching in order to determine whether EVAR or OSR provides a better clinical outcome. 6 Our aim was to perform a meta-analysis of studies with propensity-matched cohorts to investigate whether treating rAAA with EVAR is superior to OSR.…”

Section: Introductionmentioning

confidence: 99%

A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data

2021

View full text Add to dashboard Cite

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.

show abstract

Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

Cited by 47 publications

References 33 publications

Offener thorakaler und thorakoabdominaler Aortenersatz vs. f/b(T)EVAR – komplementär oder kompetitiv?

Offener thorakaler und thorakoabdominaler Aortenersatz vs. f/b(T)EVAR – komplementär oder kompetitiv?

Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair

A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data

Contact Info

Product

Resources

About