Systematic Review on Abdominal Penetrating Atherosclerotic Aortic Ulcers: Outcomes of Endovascular Repair.

Autor:	Hatzl J; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany., Böckler D; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany., Fiering J; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany., Zimmermann S; Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany., Biscshoff MS; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany., Kalkum E; Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany., Klotz R; Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany., Uhl C; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Dec; Vol. 31 (6), pp. 1027-1040. Date of Electronic Publication: 2023 Mar 04.
DOI:	10.1177/15266028231157636
Abstrakt:	Purpose: To systematically review existing evidence on outcomes of endovascular repair of abdominal atherosclerotic penetrating aortic ulcers (PAUs). Material and Methods: Cochrane Central Registry of Registered Trials (CENTRAL), MEDLINE (via PubMed), and Web of Science databases were systematically searched. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P 2020). The protocol was registered in the international registry of systematic reviews (PROSPERO CRD42022313404). Studies reporting on technical and clinical outcomes of endovascular PAU repair in 3 or more patients were included. Random effects modeling was used to estimate pooled technical success, survival, reinterventions, and type 1 and type 3 endoleaks. Statistical heterogeneity was assessed using the I 2 statistic. Pooled results are reported with 95% confidence intervals (CIs). Study quality was assessed using an adapted version of the Modified Coleman Methodology Score. Results: Sixteen studies including 165 patients with a mean/median age ranging from 64 to 78 years receiving endovascular therapy for PAU between 1997 and 2020 were identified. Pooled technical success was 99.0% (CI: 96.0%-100%). In all, 30-day mortality was 1.0% (CI: 0%-6.0%) with an in-hospital mortality of 1.0% (CI: 0.0%-13.0%). There were no reinterventions, type 1, or type 3 endoleaks at 30 days. Median/mean follow-up ranged from 1 to 33 months. Overall, there were 16 deaths (9.7%), 5 reinterventions (3.3%), 3 type 1 (1.8%), and 1 type 3 endoleak (0.6%) during follow-up. The quality of studies was rated low according to the Modified Coleman score at 43.4 (+/- 8.5) of 85 points. Conclusion: There is low-level evidence on outcomes of endovascular PAU repair. While in the short-term endovascular repair of abdominal PAU seems safe and effective, mid-term and long-term data are lacking. Recommendations with regard to treatment indications and techniques in asymptomatic PAU should be made cautiously. Clinical Impact: This systematic review demonstrated that evidence on outcomes of endovascular abdominal PAU repair is limited. While in the short-term endovascular repair of abdominal PAU seems safe and effective, mid-term and long-term data are lacking. In the context of a benign prognosis of asymptomatic PAU and lacking standardization in current reporting, recommendations with regard to treatment indications and techniques in asymptomatic PAUs should be made cautiously. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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