The Bell-Bottom Technique Versus Branched Stent Grafts in Endovascular Treatment of Diseased Common Iliac Artery: A Systematic Review and Meta-Analysis.

Autor:	Pimentel Junior DS; Faculdade de Medicina da Universidade Federal Fluminense, Niterói, Brazil. Electronic address: dilsonj@id.uff.br., Fernandez MG; Escola Bahiana de Medicina e Saúde Pública, Bahia, Brazil., Ocke Reis PE; Departamento de Cirurgia Geral e Especializada da Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, Brazil., Florêncio de Mesquita C; Faculdade de Medicina da Universidade Federal de Pernambuco, Recife, Brazil., Díaz Herrera BÁ; Universidad Autónoma del Estado de Hidalgo and Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico., Mastra Fontoura MM; Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Bertolino EP; Faculdade de Medicina da Universidade Estadual de Maringá, Paraná, Brazil., Mazotti de Moraes T; Departamento de Cirurgia Vascular e Endovascular do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil., De Luccia N; Departamento de Cirurgia Vascular e Endovascular do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil., Mulatti GC; Departamento de Cirurgia Vascular e Endovascular do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2025 Jan; Vol. 110 (Pt A), pp. 396-405. Date of Electronic Publication: 2024 Oct 10.
DOI:	10.1016/j.avsg.2024.08.028
Abstrakt:	Background: To evaluate whether the use of iliac branched endoprosthesis reduces perioperative complications compared to the bell-bottom technique (BBT) in patients with common iliac artery aneurysm or ectasia. Methods: We conducted a systematic search of studies in the PubMed, Embase, and Cochrane databases up to March 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol, 91 articles were analyzed. A restricted maximum likelihood model with random effects with odds ratios and 95% confidence intervals was applied for binary outcomes. Heterogeneity was assessed using the Cochrane Q test and Higgins and Thompson's I 2 statistic. Significance was defined as a P value < 0.05. Results: Six cohort studies involving 2,899 patients were included, of which 863 underwent repair with branched endoprosthesis. There was no statistically significant difference observed for endoleaks: of any type (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.10-1.60; P = 0.20), type 1a (OR 1.12; 95% CI 0.20-6.40; P = 0.90), type 1b (OR 0.63; 95% CI 0.20-1.97; P = 0.42), and type 2 (OR 0.52; 95% CI 0.10-2.71; P = 0.44). However, type 3 endoleaks were less frequent in the bell-bottom group (OR 9.00; 95% CI 1.09-74.17; P = 0.04). Additionally, perioperative mortality (OR 0.73; 95% CI 0.41-1.27; P = 0.26), mesenteric ischemia (OR 0.14; 95% CI 0.01-2.54; P = 0.18), iliac artery injury (P = 0.06), and buttock claudication (OR 0.14; 95% CI 0.02-1.08; P = 0.06) also did not statistically differ between the 2 groups. Conclusions: Branched endoprosthesis and BBTs did not differ regarding perioperative mortality rates, internal iliac artery occlusion, and mesenteric ischemia rates. However, the use of branched endoprostheses was associated with a higher incidence of type 3 endoleaks compared to the BBT. (Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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