Fenestrated and chimney endovascular aneurysm repair versus open surgery for complex abdominal aortic aneurysms

Almonacil, Vicente Sala; Jm, Zaragozá-García; Ramírez-Montoya, M; Molina-Nácher, Vicente; Martínez-Perelló, I.; Fj, Gómez-Palonés

doi:10.23736/s0021-9509.17.09727-0

Cited by 2 publications

(8 citation statements)

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“…We included 15 studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 25 was included as the 15th study because it contains 2-year follow-up data from the 2015 study by Michel et al 24 Of the 20 studies that had met the inclusion criteria, five had contained duplicate data presented in other studies and, therefore, were excluded from the present meta-analysis. [31][32][33][34][35] No randomized controlled trials had evaluated the outcomes of endovascular vs open repair for JRAs.…”

Section: Resultsmentioning

confidence: 99%

“…Variable Sala-Almonacil et al 16 Bruen et al 17 Chinsakchai et al 18 Donas et al 19 Fiorucci et al 20 One point was given for a positive answer and zero points for a negative or unclear answer.…”

Section: Table II Study Bias Assessmentmentioning

confidence: 99%

“…to determine the exact number of studies that had included pararenal and suprarenal aneurysms. Three studies had included type IV thoracoabdominal aneurysms 16,24,29 ; however, Michel et al 24,25 had presented data separately for type IV aneurysms. Therefore, only the data from Sala-Almonacil et al 16 and Tsilimparis et al 29 have been presented that included these cases.…”

Section: Table II Study Bias Assessmentmentioning

confidence: 99%

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A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

Doonan

Girsowicz

Dubois

et al. 2019

Journal of Vascular Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Table II Study Bias Assessmentmentioning

confidence: 99%

Section: Table II Study Bias Assessmentmentioning

confidence: 99%

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A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

Doonan

Girsowicz

Dubois

et al. 2019

Journal of Vascular Surgery

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“…A lack of precise and objective information regarding aneurysm neck anatomy, pooling of shortneck aneurysms with aneurysms without a neck as well as aneurysms of the visceral aortic segment and thoracoabdominal aortic aneurysms seriously limits the value of most published evidence. [11][12][13][14] These sources of bias, confounding and heterogeneity, have been consistently recognised as weaknesses in the evidence base by authors of systematic reviews. 15 16 There is therefore a pressing need to generate comparative effectiveness evidence in this area with adequate internal and external validity.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, in most analyses, patients are grouped by the operation techniques used rather than the detail of the anatomy being treated. A lack of precise and objective information regarding aneurysm neck anatomy, pooling of short-neck aneurysms with aneurysms without a neck as well as aneurysms of the visceral aortic segment and thoracoabdominal aortic aneurysms seriously limits the value of most published evidence 11–14. These sources of bias, confounding and heterogeneity, have been consistently recognised as weaknesses in the evidence base by authors of systematic reviews 15 16…”

Section: Introductionmentioning

confidence: 99%

A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms—the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol

et al. 2021

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IntroductionIn one-third of all abdominal aortic aneurysms (AAAs), the aneurysm neck is short (juxtarenal) or shows other adverse anatomical features rendering operations more complex, hazardous and expensive. Surgical options include open surgical repair and endovascular aneurysm repair (EVAR) techniques including fenestrated EVAR, EVAR with adjuncts (chimneys/endoanchors) and off-label standard EVAR. The aim of the UK COMPlex AneurySm Study (UK-COMPASS) is to answer the research question identified by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme: ‘What is the clinical and cost-effectiveness of strategies for the management of juxtarenal AAA, including fenestrated endovascular repair?’Methods and analysisUK-COMPASS is a cohort study comparing clinical and cost-effectiveness of different strategies used to manage complex AAAs with stratification of physiological fitness and anatomical complexity, with statistical correction for baseline risk and indication biases. There are two data streams. First, a stream of routinely collected data from Hospital Episode Statistics and National Vascular Registry (NVR). Preoperative CT scans of all patients who underwent elective AAA repair in England between 1 November 2017 and 31 October 2019 are subjected to Corelab analysis to accurately identify and include every complex aneurysm treated. Second, a site-reported data stream regarding quality of life and treatment costs from prospectively recruited patients across England. Site recruitment also includes patients with complex aneurysms larger than 55 mm diameter in whom an operation is deferred (medical management). The primary outcome measure is perioperative all-cause mortality. Follow-up will be to a median of 5 years.Ethics and disseminationThe study has received full regulatory approvals from a Research Ethics Committee, the Confidentiality Advisory Group and the Health Research Authority. Data sharing agreements are in place with National Health Service Digital and the NVR. Dissemination will be via NIHR HTA reporting, peer-reviewed journals and conferences.Trial registration numberISRCTN85731188.

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Systematic Review and Meta-analysis of Short-term and Mid-term Outcomes After Use of t-Branch Off-the-shelf Multibranched Endograft for Elective and Urgent Treatment of Thoracoabdominal Aortic Aneurysms

Chen,

Liu,

Wang

et al. 2023

J Endovasc Ther

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Objective: To conduct a meta-analysis to assess the safety and efficacy of t-Branch off-the-shelf multibranched endograft for the treatment of thoracoabdominal aortic aneurysm (TAAA). Data Sources: PubMed, Embase, and Web of Science. Review Methods: Online databases were searched from June 2012 to March 2023. The data were pooled together using a random-effects model of proportions. The outcomes overall included technical success, spinal cord ischemia, target vessel occlusion, type I or III endoleak, reintervention, early mortality (30-day), and mid-term outcomes. Subgroup meta-analyses and meta-regression were performed to explore variation among studies. Results: A total of 15 studies containing 1238 patients were included in the meta-analysis. The overall study quality assessment was found to be moderate to good. The pooled technical success was 97.0% (95% confidence interval [CI]=95.5–98.6, I2=53.01%, 1185/1238 cases, 15 studies). Overall, early mortality was 7.3% (95% CI=4.4–10.1, I2=74.48%, 124/1238 cases, 15 studies). Early spinal cord ischemia was 13.4% (95% CI=9.6–17.2, I2 =67.24%, 160/1238 cases, 15 studies), and early type I or III endoleak was 6.0% (95% CI=3.4–8.5, I2=53.71%, 68/1032 cases, 9 studies). Mid-term outcomes showed target vessel occlusion was 4% (95% CI=1.4–6.5, I2=65.18%, 28/528 cases, 10 studies, 5–21.2 months), type I or III endoleak was 4.7% (95% CI=2–7.5, I2=49.74%, 38/512 cases, 10 studies, 5-21.2 months), reintervention was 11.2% (95% CI=8.1–14.3, I2=31.06%, 85/650 cases, 10 studies, 5–21.2 months), and pooled mortality was 13.9% (95% CI=7.2–20.7, I2 =76.32%, 84/550 cases, 11 studies, 5–21.2 months). Meta-regression found a significant linear association between higher technical success and earlier publication year (p=0.014) and studies with anatomic inclusion criteria (p=0.037). Urgent patients (p=0.021) and later publication year (p=0.048) were significantly associated with higher early mortality. Conclusion: The use of the off-the-shelf t-Branch multibranched endograft for elective or urgent endovascular TAAA repair is associated with high technical success rates and proved to be safe and effective at early and mid-term follow-up. However, the heterogeneity between the included studies is high, and prospective, randomized studies along with future larger studies with long-term follow-up are needed. Clinical Impact The Zenith t-Branch (Cook Medical, Bloomington, Ind) was approved as a commercially available device in Europe in June 2012. Although a decade has past, the outcomes of t-Branch have rarely been synthesized at the global level. This meta-analysis included 15 studies containing 1238 patients. The meta-analyses included technical success, major adverse events, reintervention, early mortality, and mid-term outcomes. The outcome was very meaningful and representative for the use of t-Branch. It is helpful for endovascular surgeons to make decisions on the treatment of TAAA patients.

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Fenestrated and chimney endovascular aneurysm repair versus open surgery for complex abdominal aortic aneurysms

Cited by 2 publications

References 0 publications

A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms—the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol

Systematic Review and Meta-analysis of Short-term and Mid-term Outcomes After Use of t-Branch Off-the-shelf Multibranched Endograft for Elective and Urgent Treatment of Thoracoabdominal Aortic Aneurysms

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