Stent graft types for endovascular repair of thoracic aortic aneurysms

Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

BACKGROUND

Thoracoabdominal aortic aneurysms (TAAAs) are a life-threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment options for patients, however, due to the lack of clinical trials comparing these, the optimum treatment option is unknown.

OBJECTIVES

To assess the effectiveness and safety of endovascular repair versus conventional OSR for the treatment of TAAAs.

SEARCH METHODS

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.

SELECTION CRITERIA

We considered all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing endovascular repair to OSR for TAAAs for inclusion in the review. The main outcomes of interest were prevention of aneurysm rupture (participants without aneurysm rupture up to 5 years from intervention), aneurysm-related mortality (30 days and 12 months), all-cause mortality, spinal cord ischaemia (paraplegia, paraparesis), visceral arterial branch compromise causing mesenteric ischaemia or renal failure, and rate of reintervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all titles and abstracts identified from the searches to identify those that met the inclusion criteria. We planned to undertake data collection, risk of bias assessment, and analysis in accordance with Cochrane recommendations. We planned to assess the certainty of the evidence using GRADE.

MAIN RESULTS

No RCTs or CCTs met the inclusion criteria for this review.

AUTHORS' CONCLUSIONS

Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of endovascular compared to OSR in patients with TAAAs and are unable to provide any evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs addressing this objective are necessary, however conducting such studies will be logistically and ethically challenging for this life-threatening disease.

Stent graft types for endovascular repair of abdominal aortic aneurysms

BACKGROUND

The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. This is an update of the review first published in 2013.

OBJECTIVES

This review aimed to assess the different stent graft types for endovascular repair of AAA.

SEARCH METHODS

The Cochrane Vascular Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2015) and the Cochrane Register of Studies (2015, Issue 1). Trial databases were searched by the TSC for details of ongoing and unpublished studies.

SELECTION CRITERIA

All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of AAAs were sought without language restriction and in consultation with the Cochrane Vascular Group TSC.

DATA COLLECTION AND ANALYSIS

We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

MAIN RESULTS

No studies were identified that met the inclusion criteria. It was not possible to review the quality of the evidence in the absence of studies eligible for inclusion in the review.

AUTHORS' CONCLUSIONS

Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.