Spinal cord injury after open and endovascular repair of descending thoracic aneurysm and thoracoabdominal aortic aneurysm: an updated systematic review and meta-analysis.
Spinal cord injury after open and endovascular repair of descending thoracic aneurysm and thoracoabdominal aortic aneurysm: an updated systematic review and meta-analysis.
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DOI：
10.21037/acs-2023-scp-14
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发表时间：
2023-09-28
影响因子：
3.1
通讯作者：
Gaudino, Mario
中科院分区：
文献类型：
--
作者：
Alzghari, Talal;An, Kevin R.;Harik, Lamia;Rahouma, Mohamed;Dimagli, Arnaldo;Perezgorvas-Olaria, Roberto;Demetres, Michelle;Cancelli, Gianmarco;Soletti Jr, Giovanni;Lau, Christopher;Girardi, Leonard N.;Gaudino, Mario
关键词：
脊髓损伤（SCI）是胸降段动脉瘤（DTA）或胸腹主动脉瘤（TAAA）开放或腔内修复术后的一种罕见但严重的并发症。本荟萃分析旨在对SCI发生率和SCI相关因素进行全面评估。于2022年9月进行了一次系统性文献检索，查找2018年之后发表的关于DTA和/或TAAA开放和/或腔内修复术的研究，以更新我们先前发表的荟萃分析结果。主要结局为永久性SCI。次要结局为暂时性SCI、30天和住院死亡率、随访死亡率、术后卒中和脑脊液（CSF）引流相关并发症。使用逆方差加权将数据合并为比例。共纳入239项研究（71项新研究和168项来自我们之前的荟萃分析）和61，962例患者。永久性SCI的总体合并率为3.3% [95%置信区间（CI），2.9-3.8%]。开放性修复术的永久性SCI发生率为4.0%（95% CI，3.3-4.8%），腔内修复术的永久性SCI发生率为2.9%（95% CI，2.4-3.5%）。永久性SCI为2.0% DTA修复后（95% CI，1.2-3.3%），4.7%（95% CI，3.9-5.6%）;永久性脊髓损伤发生率为3.8%（95% CI，2.9-5.0%）Crawford I级，13.4%（95% CI，9.0-19.5%），III期为7.1%（95% CI，5.7-8.9%），IV期为2.3%（95% CI，1.6-3.5%），V期为6.7%（95% CI，1.7-23.1%）。CSF引流相关并发症的合并发生率为1.9%（95% CI，0.8-4.7%）（重度）、0.4%（95% CI，0.0-4.0%）（中度）和1.8%（95% CI，0.6-5.6%）（轻度）。永久性SCI发生在血管内和开放性DTA或TAAA修复后。与血管内或DTA修复术相比，开放性修复术和TAAA修复术的SCI风险更高。特别是，II度动脉瘤的SCI的总体风险最高。
Spinal cord injury (SCI) is a rare but severe complication after open or endovascular repair of descending thoracic aneurysms (DTAs) or thoracoabdominal aortic aneurysms (TAAAs). This meta-analysis aims to provide a comprehensive assessment of SCI rates and factors associated with SCI. A systematic literature search was performed in September 2022 looking for studies on open and/or endovascular repair of DTA and/or TAAA published after 2018, to update the results of our previously published meta-analysis. The primary outcome was permanent SCI. Secondary outcomes were temporary SCI, 30-day and in-hospital mortality, follow-up mortality, postoperative stroke, and cerebrospinal fluid (CSF) drain-related complications. Data were pooled as proportions using inverse-variance weighting. A total of 239 studies (71 new studies and 168 from our previous meta-analysis) and 61,962 patients were included. The overall pooled rate of permanent SCI was 3.3% [95% confidence interval (CI), 2.9–3.8%]. Open repair was associated with a permanent SCI rate of 4.0% (95% CI, 3.3–4.8%), and endovascular repair was associated with a permanent SCI rate of 2.9% (95% CI, 2.4–3.5%). Permanent SCI was 2.0% (95% CI, 1.2–3.3%) after DTA repair, and 4.7% (95% CI, 3.9–5.6%) after TAAA repair; permanent SCI rate was 3.8% (95% CI, 2.9–5.0%) for Crawford extent I, 13.4% (95% CI, 9.0–19.5%) for extent II, 7.1% (95% CI, 5.7–8.9%) for extent III, 2.3% (95% CI, 1.6–3.5%) for extent IV, and 6.7% (95% CI, 1.7–23.1%) for extent V TAAA aneurysms. The pooled rate of CSF drain related complications was 1.9% (95% CI, 0.8–4.7%) for severe, 0.4% (95% CI, 0.0–4.0%) for moderate, and 1.8% (95% CI, 0.6–5.6%) for minor complications. Permanent SCI occurs after both endovascular and open DTA or TAAA repairs. Open repairs and TAAA repairs have higher risk of SCI compared with endovascular or DTA repairs. In particular, extent II aneurysms present the highest overall risk of SCI.
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影响因子：
12.7
作者：
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通讯作者：
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