Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR)

Vascular, vol. 30, pp. 405–417

Abstract

OBJECTIVES: To collect and analyse the available evidence in the outcomes of patients treated with fenestrated endovascular aortic repair (f-EVAR) technique focusing specifically on visceral vessel outcomes. METHODS: The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the studies reporting the f-EVAR technique for the management of degenerative pararenal and/or type IV thoracoabdominal aortic aneurysms (TAAA) were considered eligible for inclusion in the study. The main study outcomes (technical success, type I endoleaks, fracture or occlusion of the bridging stents, overall aneurysm-related mortality, and the reintervention rate) were subsequently expressed as proportions and 95% confidence intervals. RESULTS: Fourteen studies with a total of 1804 patients were included in a pooled analysis. The technical success of the procedure was 95.97% (95%CI = 92.35-98.60). Intraoperatively, the pooled proportion of reported type I endoleak was 7.6% (95%CI = 2.52-14.60) while during a median follow-up of 41 months (range 11-96) follow-up period the pooled rate of fracture and occlusion of the bridging stents was 2.79% (95%CI = 0.00-8.52) and 4.46% (95%CI = 1.93-7.77), respectively. The overall aneurysm-related mortality was detected to be 0.63% (95%CI = 0.04-1.63), and the pooled estimate for re-intervention rate was 15.69%. CONCLUSIONS: Fenestrated endovascular repair for p-AAA is an effective and safe treatment. Target vessel complications and endoleaks remain the two most important concerns for fenestrated endovascular procedures, contributing to most of the secondary interventions. The lack of computed tomography angiography follow-up evaluation does not allow us to draw robust conclusions about the complication rates for the superior mesenteric artery during f-EVAR. Due to the potential implications of SMA complications on aneurysm-related mortality, standardized reporting of short- and long-term target visceral vessel outcomes is required.

Authors 6

1. Georgios Karaolanis corresponding

   University of Ioannina

   Affiliation as printed

   Vascular Unit, Department of Surgery, University of Ioannina, and of School of Medicine, Ioannina, Greece

2. Constantine N. Antonopoulos

   Evangelismos Hospital

   Affiliation as printed

   Cardiothoracic and Vascular Surgery Department, General Hospital of Athens “Evangelismos”, Athens, Greece

3. Salvatore T. Scali

   University of Florida

   Affiliation as printed

   Division of Vascular Surgery, University of Florida, Gainesville, FL, USA

4. Stylianos G. Koutsias

   University of Ioannina

   Affiliation as printed

   Vascular Unit, Department of Surgery, University of Ioannina, and of School of Medicine, Ioannina, Greece

5. Drosos Kotelis Aachen Department of Vascular Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany

6. Konstantinos P. Donas

   Goethe University Frankfurt · Asklepios Klinik Langen

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, Research Vascular Centre, Asclepios Clinic Langen, University of Frankfurt, Germany