Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?
Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?
复制标题
主动脉瘤腔内修复术中可以安全地覆盖副肾动脉吗？
DOI：
10.1093/icvts/ivt382
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发表时间：
2013
影响因子：
--
通讯作者：
G. Georgiadis
中科院分区：
文献类型：
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作者：
G. Antoniou;C. Karkos;S. Antoniou;G. Georgiadis
根据结构化协议构建了最佳证据主题。所解决的问题是，在行主动脉瘤腔内修复术(EVAR)的患者中，副肾动脉(ARA)的覆盖率是否与肾损害的风险增加有关。使用报告的搜索总共找到了106篇论文，其中5篇是回答这个问题的最佳证据。这些论文的作者、期刊、发表日期和国家、研究类型、研究的患者组、相关的结果参数和结果都列在表格中。我们的最佳证据分析包括116名患者，他们在EVAR中排除了一种或多种ARA。节段性肾梗死发生在不同数量的患者(从0到84%不等)。作者一致认为，肾质量的减少与功能性肾损害无关，表现为各种预后参数，如血清肌酐、肾小球滤过率(GFR)、需要透析的肾功能衰竭和高血压恶化。通过一项选定的研究对有覆盖或保留ARA的患者组进行比较，发现除了前者肾梗死体积显著增加(P<；0.001)外，在这些肾脏结果参数中没有任何差异。对既往肾功能不全患者(GFR和lt；60ml/h/m(2))的亚组分析显示，与未覆盖的ARA患者队列相比，GFR的变化没有差异。在这些研究中没有报道与被覆盖的ARA相关的II型内渗漏。综上所述，目前的证据支持在近端固定区覆盖ARA以实现EVAR的封闭是安全的。
A best evidence topic was constructed according to a structured protocol. The question addressed was whether coverage of an accessory renal artery (ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is associated with increased risk of renal impairment. Altogether, 106 papers were located using the reported searches, of which 5 represented the best evidence to answer the question. The authors, journal, date and country of publication, study type, patient group studied, relevant outcomes parameters and results of these papers are tabulated. Our best evidence analysis included 116 patients who had one or more ARA excluded during EVAR. Segmental renal infarction occurred in varying numbers of patients (ranging from 0 to 84%). The authors consistently demonstrate that loss of renal mass is not associated with functional renal impairment, expressed by various outcome parameters such as serum creatinine, glomerular filtration rate (GFR), renal failure requiring dialysis and worsening hypertension. Comparisons of groups of patient with covered or preserved ARAs by one of the selected studies showed no difference in any of these renal outcome parameters, apart from a significantly higher renal infarct volume in the former group (P < 0.001). Subgroup analysis of patients with pre-existing renal dysfunction (GFR < 60 ml/h/m(2)) showed no difference in GFR change when comparing covered with uncovered ARA patient cohorts. No type II endoleak related to the covered ARA was reported in any of these studies. In conclusion, current evidence supports the safety of coverage of ARAs located in the proximal fixation zone to achieve seal in EVAR.