Systematic review and network meta-analysis of pre-emptive embolization of the aneurysm sac side branches and aneurysm sac coil embolization to improve the outcomes of endovascular aneurysm repair.
Systematic review and network meta-analysis of pre-emptive embolization of the aneurysm sac side branches and aneurysm sac coil embolization to improve the outcomes of endovascular aneurysm repair.
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DOI：
10.3389/fcvm.2022.947809
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发表时间：
2022
影响因子：
3.6
通讯作者：
Wei, Guo
中科院分区：
文献类型：
--
作者：
Wu, Ye;Yin, Jianhan;Hongpeng, Zhang;Wei, Guo
关键词：
既往报告显示，腹主动脉瘤腔内修复术后II型内漏（T2 EL）的发生率较高。通过动脉瘤囊侧支（ASSB）和动脉瘤囊弹簧圈栓塞（ASCE）的预先栓塞，降低了腹主动脉瘤腔内修复术后T2 EL的发生率。本研究旨在研究T2 EL的不同预防性干预是否与抑制动脉瘤囊扩张和降低再次干预率相关。检索了PubMed、Web of Science、MEDLINE和Embase数据库以及会议记录，以识别关于腹主动脉瘤腔内修复术伴或不伴栓塞的文章。本研究的开发符合参与者、干预、比较、结局和研究设计原则，并根据系统性综述和荟萃分析指南的首选报告项目进行和报告。我们使用基于多变量随机效应荟萃分析的网络荟萃分析间接比较腹主动脉瘤腔内修复术期间不同栓塞策略的结局。共有31项研究符合所有纳入标准，并被纳入定性和定量综合。纳入的研究发表于2001年至2022年，共分析了18，542例患者，包括1，882例在腹主动脉瘤腔内修复术期间接受预防性栓塞治疗的患者（实验组）和16，660例在腹主动脉瘤腔内修复术期间未接受预防性栓塞治疗的患者（对照组）。肠系膜下动脉（IMA）的预先栓塞（IMA-ASSB）在预防T2 EL方面的作用与ASSB（NS-ASSB）和ASCE的非选择性栓塞（RR 0.88，95% CI 0.40-1.96）相似（相对风险[RR] 1.01，95%置信区间[CI] 0.38-2.63）。IMA-ASSB在抑制动脉瘤囊扩张方面具有较好的临床效果（与NS-ASSB相比，RR 0.27，95%CI 0.09-2.25;与ASCE相比，RR 0.93，95%CI 0.16-5.56）和降低再干预率（与NS-ASSB相比，RR 0.34，95% CI 0.08-1.53;与ASCE相比，RR 0.66，95% CI 0.19-2.22）。所有预防性栓塞策略均改善了腹主动脉瘤腔内修复术的临床结局。腹主动脉瘤腔内修复术期间的预防性栓塞可有效预防T2 EL，抑制动脉瘤囊扩张，并降低再次介入率。IMA栓塞证实了在实现长期动脉瘤囊稳定性和降低二次手术风险方面的受益。NS-ASSB更有效地降低了T2 EL的发生率，而IMA栓塞单独或联合ASCE增强了腹主动脉瘤腔内修复术的临床受益。此外，由于网络荟萃分析仍然是一种基于现有数据细化的间接方法，未来仍需要更多的研究和证据来建立更可信的结论。
Previous reports have revealed a high incidence of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR). The incidence of T2EL after EVAR is reduced by pre-emptive embolization of aneurysm sac side branches (ASSB) and aneurysm sac coil embolization (ASCE). This study aimed to investigate whether different preventive interventions for T2EL were correlated with suppression of aneurysm sac expansion and reduction of the re-intervention rate. The PubMed, Web of Science, MEDLINE and Embase databases, and conference proceedings were searched to identify articles on EVAR with or without embolization. The study was developed in line with the Participants, Interventions, Comparisons, Outcomes, and Study design principles and was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We used network meta-analysis based on multivariate random-effects meta-analysis to indirectly compare outcomes of different strategies for embolization during EVAR. A total of 31 studies met all inclusion criteria and were included in the qualitative and quantitative syntheses. The included studies were published between 2001 and 2022 and analyzed a total of 18,542 patients, including 1,882 patients who received prophylactic embolization treatment during EVAR (experimental group) and 16,660 who did not receive prophylactic embolization during EVAR (control group). The effect of pre-emptive embolization of the inferior mesenteric artery (IMA) (IMA-ASSB) in preventing T2EL was similar (relative risk [RR] 1.01, 95% confidence interval [CI] 0.38–2.63) to the effects of non-selective embolization of ASSB (NS-ASSB) and ASCE (RR 0.88, 95% CI 0.40–1.96). IMA-ASSB showed a better clinical effect in suppressing the aneurysm sac expansion (RR 0.27, 95% CI 0.09–2.25 compared with NS-ASSB; RR 0.93, 95% CI 0.16–5.56 compared with ASCE) and reducing the re-intervention rate (RR 0.34, 95% CI 0.08–1.53 compared with NS-ASSB; RR 0.66, 95% CI 0.19–2.22 compared with ASCE). All prophylactic embolization strategies improved the clinical outcomes of EVAR. Prophylactic embolization during EVAR effectively prevents T2EL, suppresses the aneurysm sac expansion, and reduces the re-intervention rate. IMA embolization demonstrated benefits in achieving long-term aneurysm sac stability and lowering the risk of secondary surgery. NS-ASSB more effectively reduces the incidence of T2EL, while IMA embolization alone or in combination with ASCE enhances the clinical benefits of EVAR. In addition, as network meta-analysis is still an indirect method based on a refinement of existing data, more studies and evidence are still needed in the future to establish more credible conclusions.
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