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Krisna Pertiwi PF, Sudarma IW, Prana Jagannatha GN, Kosasih AM, Dyah Yustika Dewi CI, Angga Wijaya IGA. Outcomes of advanced EVAR versus open surgery in the management of complex abdominal aortic aneurysm repair: A systematic review and meta-analysis. Asian Cardiovasc Thorac Ann 2024:2184923241262847. [PMID: 38887046 DOI: 10.1177/02184923241262847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Open surgery is still acknowledged as the gold standard for complex abdominal aortic aneurysm (c-AAA). Recently, advanced-endovascular aortic aneurysm repair (EVAR) for c-AAA has been developed, but its effectiveness compared to open surgery is still unclear. METHOD A systematic search was performed on the MEDLINE through PubMed and ScienceDirect databases. The search was aimed to investigate outcomes of both fenestrated- and chimney-EVAR (consider as advanced EVAR) compared to open surgery in c-AAA. Outcomes included postoperative complications, 30-day mortality, long-term mortality, and reintervention rate. Data were collected using the Mantel-Haenszel fixed effects model with relative risk (RR) as the effect size with 95% confidence interval (CI). RESULTS A total of 25 studies (n = 12,845 patients) were included in our study. The results demonstrated that advanced-EVAR correlated with diminished postoperative complications (RR 0.53; 95% CI 0.49-0.57; p < 0.001) compared to open surgery. Advanced-EVAR was associated with lower 30-day mortality compared to open surgery (RR 0.66; 95% CI 0.53-0.82; p < 0.001). Subgroup analysis revealed that fenestrated-EVAR resulted in superior outcomes (p < 0.001), whereas the chimney-EVAR subgroup did not show significant differences (p = 0.79), compared to open surgery in terms of 30-day mortality. Unfortunately, advanced-EVAR was associated with a higher long-term mortality rate (RR 1.46; 95% CI 1.20-1.78; p < 0.001) and a higher reintervention rate (RR 1.26; 95% CI 1.01-1.59; p = 0.04) compared to open surgery. CONCLUSION Advanced EVAR, especially fenestrated-EVAR, presented better short-term outcomes compared to open surgery; however, it failed to demonstrate superiority over open surgery in improving long-term outcomes.
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Affiliation(s)
- Putu Febry Krisna Pertiwi
- Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - I Wayan Sudarma
- Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Udayana University, Indonesia/Prof. Dr I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | | | - Anastasya Maria Kosasih
- Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | | | - I Gusti Agung Angga Wijaya
- Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Accarino G, De Vuono F, Accarino G, Fornino G, Puca AE, Fimiani R, Parrella V, Savarese G, Furgiuele S, Vecchione C, Galasso G, Bracale UM. Endurant Stent Graft for Treatment of Abdominal Aortic Aneurysm Inside and Outside of the Instructions for Use for the Proximal Neck: A 14-Year, Single-Center Experience. J Clin Med 2024; 13:2589. [PMID: 38731118 PMCID: PMC11084245 DOI: 10.3390/jcm13092589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Aim: To assess the medium and long-term performance of the Endurant stent graft in a cohort of consecutive patients treated with this device for an abdominal aortic aneurysm (AAA) both inside and outside of the instructions for use (IFU) and to find factors influencing the outcomes. Methods: Our observational, retrospective, single-center study included all patients who consecutively underwent endovascular aneurysm repair with the Endurant stent graft from February 2009 to January 2023. Patients with an AAA to treat according to current guidelines were included. Patients were divided into two groups: Group 1 inside of the IFUs and Group 2 outside of the IFUs for the proximal aortic neck. Patients were followed up after the procedure with computed angiography tomography, ultrasound examination, and interviews. Aneurysm-related mortality, procedure-related reinterventions, and type IA and III endoleaks were considered primary endpoints. Secondary endpoints included aneurysmal sac variations and graft thrombosis. Results: A total of 795 patients were included, 650 in Group 1 and 145 in Group 2; 732 were males, and the mean age was 74 ± 8. Anamnestic baseline did not differ between the two groups. Neck length, width, and angulation were different between the two groups (all p < 0.001). A total of 40 patients had a ruptured AAA, while 56 were symptomatic. At a mean follow-up of 43 ± 39 months, aneurysm-related mortality was less than 1%, and 82 endoleak (10.5%) were observed. Overall endoleak rate and type 1A endoleak, as well as procedure-related reintervention, were significantly more frequent in Group 2. Sac regression of at least 5 mm was observed in 65.9% of cases. AAAs larger than 60.5 mm carried a higher risk of endoleak (HR: 1.025; 95% CI: 1.013-1.37; p < 0.001) and proximal necks shorter than 13.5 mm carried a higher type 1A risk (HR: 0.890; 95% CI: 0.836-0.948; p < 0.001). Patients without chronic obstructive pulmonary disease and taking lipid-lowering drugs had an overall more consistent sac-shrinking rate. Conclusions: The Endurant stent graft proves safe and reliable. Out-of-IFU treatment has poorer medium and long-term outcomes. Some conditions influence medium and long-term reintervention risk and sac behavior. Patients with bigger aneurysms, proximal necks shorter than 13.5 mm, and chronic obstructive pulmonary disease should be more carefully evaluated during follow-up. Consistent follow-up is in keeping low aneurysm-related mortality. Personalized risk profiles and peri and postoperative management strategies are needed.
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Affiliation(s)
- Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Francesco De Vuono
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giancarlo Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Aniello Enrico Puca
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Rodolfo Fimiani
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
| | - Valentina Parrella
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy; (G.F.); (A.E.P.); (R.F.); (V.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Giovanni Savarese
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
| | - Sergio Furgiuele
- Vascular Surgery Unit, Struttura Ospedaliera ad Alta Specialità Mediterranea, 80122 Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy; (F.D.V.); (G.A.); (C.V.); (G.G.)
| | - Umberto Marcello Bracale
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (G.S.); (U.M.B.)
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Chen J, Sheng Y. Outcomes of abdominal aortic aneurysm repairs: Endovascular aneurysm vs open surgical repairs. Asian J Surg 2021; 44:1492. [PMID: 34588137 DOI: 10.1016/j.asjsur.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jing Chen
- Shiyan Maternal and Child Health Hospital, Shiyan, Hubei, China
| | - Yan Sheng
- Shiyan Maternal and Child Health Hospital, Shiyan, Hubei, China.
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