Meta‐analysis and meta‐regression analysis of iliac limb occlusion after endovascular aneurysm repair
Meta‐analysis and meta‐regression analysis of iliac limb occlusion after endovascular aneurysm repair
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动脉瘤腔内修复术后髂肢闭塞的Meta分析和荟萃回归分析
DOI：
10.1016/j.jvs.2018.08.153
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发表时间：
2018
影响因子：
4.3
通讯作者：
G. Antoniou
中科院分区：
文献类型：
--
作者：
A. Hammond;V. Hansrani;C. Lowe;I. Asghar;S. Antoniou;G. Antoniou
目的探讨血管内动脉瘤修补术(EVAR)后髂肢闭塞的发生率、干预措施和预后。方法采用注册方案(CRD42017064375)进行符合系统综述和Meta分析指南的系统综述。我们考虑了报告EVAR后发生髂肢闭塞患者的研究。我们使用自由文本和受控词汇搜索相结合的方式询问电子信息源和参考书目列表。我们应用随机效应模型对结果进行了比例荟萃分析。我们使用混合效应(矩方法)回归模型来研究髂肢闭塞的发生率是否随着时间的推移而变化。结果我们确定了13项研究，报告了1995-2014年间共5454例接受EVAR的患者。合并发生率估计为5.6%(95%可信区间为4.0-7.8)。在旧的研究中，髂骨肢体闭塞的发生率更为明显，而在最近发表的研究中则有所下降(斜率P=0.022；Q=5.279)。44%(95%可信区间，36%-52%)有急性症状。一半的患者(48%；95%的CI，41%-56%)在EVAR后30天内出现。17%(95%CI，13%~23%)接受血管内治疗，8%(95%CI，5%~13%)接受混合手术，61%(95%CI，54%~67%)接受开放手术。30天死亡率为0.036(95%可信区间，0.018-0.070；异质性：P=.999，I2=0%)。30天内和随访期肢体损失率分别为0.031(95%CI，0.015~0.063；异质性：P=.999；I2=0)和0.045(95%CI，0.024~0.083；异质性：P=.978；I2=0)。0.080人(95%CI，0.048-0.130；异质性P=0.919；I2=0%)进行了再干预，随访时间从7个月到39个月不等。随访期死亡率为0.056(95%CI，0.031~0.099；异质性：P=.866；I2=0)。这些患者中有一半出现得很早。尽管外科治疗已被更频繁地使用，但没有足够的证据表明其优于血管内修复/混合修复。相当数量的患者将需要再次干预。还需要进一步的研究来确定存在髂骨肢体闭塞风险的患者。
ObjectiveOur objective was to investigate the incidence, interventions and outcomes of iliac limb occlusion after endovascular aneurysm repair (EVAR).MethodsWe performed a systematic review that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines using a registered protocol (CRD42017064375). We considered studies reporting patients with iliac limb occlusion after EVAR. We interrogated electronic information sources and bibliographic reference lists using a combination of free text and controlled vocabulary searches. We conducted a proportion meta-analysis of outcomes applying a random effects model. We used mixed effects (methods of moments) regression models to investigate whether the incidence of iliac limb occlusion changed over time.ResultsWe identified 13 studies reporting a total of 5454 patients who underwent EVAR from 1995 to 2014. The pooled incidence estimate of primary iliac limb occlusion was 5.6% (95% confidence interval [CI], 4.0-7.8). The incidence of iliac limb occlusion was more pronounced in old studies and declined in more recently published studies (slopeP= .022; Q=5.279). Forty-four percent (95% CI, 36%-52%) had an acute presentation. One-half of the patients (48%; 95% CI, 41%-56%) presented within 30 days of EVAR. Seventeen percent (95% CI, 13%-23%) underwent endovascular treatment, 8% (95% CI, 5%-13%) received hybrid procedures, and 61% (95% CI, 54%-67%) had open surgery. The 30-day mortality was 0.036 (95% CI, 0.018-0.070; heterogeneity:P= .999, I2= 0%). The rate of limb loss within 30 days and during follow-up was 0.031 (95% CI, 0.015-0.063; heterogeneity:P= .999; I2= 0%) and 0.045 (95% CI, 0.024-0.083; heterogeneity:P= .978; I2= 0%), respectively. Reintervention was undertaken in 0.080 (95% CI, 0.048-0.130; heterogeneityP= .919; I2= 0%) over a follow-up ranging from 7 to 39 months. The mortality during follow-up was 0.056 (95% CI, 0.031-0.099; heterogeneity:P= .866; I2= 0%).ConclusionsIliac limb occlusion occurred in 5.6% of patients after EVAR. One-half of these patients presented early. Even though surgical treatment has been used more frequently, there is insufficient evidence to suggest its superiority over endovascular/hybrid repair. A considerable number of patients will require reintervention. Future research is needed in identifying patients at risk of iliac limb occlusion.