Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis.

Autor: Hanna L; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK. Electronic address: l.hanna@imperial.ac.uk., Lam K; Department of Surgery and Cancer, Imperial College London, UK., Agbeko AE; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK., Amoako JK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK., Ashrafian H; Institute of Global Health Innovation, Imperial College London, UK., Sounderajah V; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK; Institute of Global Health Innovation, Imperial College London, UK., Abdullah A; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK., Gibbs R; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, UK.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2022 Jun; Vol. 63 (6), pp. 828-837. Date of Electronic Publication: 2022 Feb 25.
DOI: 10.1016/j.ejvs.2022.02.026
Abstrakt: Objective: To investigate the clinical impact of coeliac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR).
Methods: This systematic review and meta-analysis was conducted according to the PRISMA guidelines. Electronic databases were searched from 1989 to 2020 for studies reporting visceral ischaemia, spinal cord ischaemia (SCI), 30 day/in hospital mortality, endoleaks, re-intervention, and caudal stent graft migration following CA coverage in patients undergoing TEVAR. Meta-analysis was conducted using random effects modelling. The quality of the evidence was graded using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
Results: Fifteen observational studies with 236 patients (108 male, age range 61.3 - 79 years) were included. The pooled visceral ischaemia rate was 13% with significant heterogeneity between studies (95% confidence intervals [CI] 4 - 24; I 2  = 72%, p < .001). The SCI rate was 5% (95% CI 2 - 9; I 2  = 0%); the 30 day/in hospital mortality was 4% (95% CI 1 - 7; I 2  = 0%); the overall endoleak rate was 21% (95% CI 13 - 29; I 2  = 35%) with a 5% (95% CI 0 - 13; I 2  = 38%) rate of type Ib and 2% (95% CI 0 - 8; I 2  = 43%) rate of type II endoleak from retrograde CA flow. The re-intervention rate was 13% (95% CI 6 - 22; I 2  = 54%); the caudal stent graft migration rate was 3% (95% CI 0 - 9, I 2  = 0%). The certainty of the body of evidence was judged to be very low for all outcomes.
Conclusion: CA coverage during TEVAR is associated with high rates of visceral ischaemia, spinal cord ischaemia, 30 day/in hospital mortality, endoleaks, and re-intervention. Although the literature is of poor quality and questions remain over effects estimates, there is evidence that CA coverage should be avoided if at all possible, during TEVAR.
Registration: PROSPERO registration number 244084.
(Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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