A Meta-analysis of Comparative Outcome and Cost-Effectiveness of Internal Iliac Artery Embolization with Vascular Plug Versus Coil
A Meta-analysis of Comparative Outcome and Cost-Effectiveness of Internal Iliac Artery Embolization with Vascular Plug Versus Coil
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DOI：
10.1007/s00270-020-02425-5
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发表时间：
2020-02-26
影响因子：
2.9
通讯作者：
Kokabi, Nima
中科院分区：
文献类型：
--
作者：
Wong, Karen;Johnson, Paige;Kokabi, Nima
目的 评估主动脉瘤腔内修复术前髂内动脉栓塞血管塞与弹簧圈的比较结果和成本。方法 对 2005 年 1 月至 2018 年 7 月期间成年患者的髂内动脉栓塞研究进行检索。纳入标准包括在主动脉腔内修复术之前用弹簧圈或栓塞对单侧或双侧 IIA 进行栓塞。使用固定效应模型和反方差加权平均法进行荟萃分析，以确定手术时间、透视时间、辐射暴露、使用的设备数量、设备成本和栓塞后臀部跛行的汇总差异。使用卡方统计量评估异质性。比较汇总结果，并使用纽卡斯尔-渥太华量表评估质量评估。结果 六项研究符合纳入标准。该研究纳入了 181 名患者，其中插头组 87 名，线圈组 94 名。与单独使用线圈相比，使用血管塞可使手术时间缩短 35.32 分钟（p < 0.001），透视时间缩短 15.64 分钟（p < 0.001），辐射减少 157,599 mGy/cm(2)（p < 0.001），闭塞装置减少 5.88 个（p < 0.001）。塞组中封堵器的估计总成本低 575.45 美元 (p < 0.001)。 EVAR 后 12 个月，插头组中发生臀部跛行的可能性降低了 11%，但没有统计学意义 (p = 0.71)。结论 血管栓塞在髂内动脉栓塞中优于弹簧圈，因为其手术时间、透视时间、辐射暴露和闭塞装置的总成本更短。
Purpose To evaluate the comparative outcome and cost of vascular plugs versus coils for internal iliac artery embolization prior to endovascular aortic aneurysm repair. Method A search was performed for internal iliac artery embolization studies in adult patients from January 2005 to July 2018. Inclusion criteria included embolization of unilateral or bilateral IIAs with either coils or plug(s) prior to endovascular aortic repair. Meta-analysis was performed using a fixed effects model with the inverse variance-weighted average method to determine pooled differences in surgical time, fluoroscopy time, radiation exposure, number of devices used, cost of devices, and post-embolization buttock claudication. Heterogeneity was assessed using the Chi-square statistic. Pooled outcomes were compared, and quality assessments were evaluated using the Newcastle-Ottawa scale. Result Six studies met inclusion criteria. One hundred and eighty-one patients were included in the study, of which 87 were in the plug group and 94 in the coil group. Vascular plug use led to 35.32 min shorter surgery time (p < 0.001), 15.64 min less fluoroscopy time (p < 0.001), 157,599 mGy/cm(2) less radiation (p < 0.001), and 5.88 fewer occlusive devices (p < 0.001) than the use of coils alone. The estimated total cost of occlusion devices was $575.45 USD lower in the plug cohort (p < 0.001). The development of buttock claudication 12 months after EVAR was 11% less likely in the plug cohort but was not statistically significant (p = 0.71). Conclusion The vascular plug appears to be superior to coils in embolization of the internal iliac artery due to shorter surgical time, fluoroscopy time, radiation exposure, and total cost of occlusive devices.