Eur J Vasc Endovasc Surg. 2023 Aug 1:S1078-5884(23)00614-7. doi: 10.1016/j.ejvs.2023.07.048. Online ahead of print.
ABSTRACT
OBJECTIVE: Fenestrated and branched thoracic endovascular aortic repair (f/b-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim is to summarise the published results of manufactured f/b-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated vs. branched configurations.
DATA SOURCES: PubMed, Scopus and The Cochrane Library were searched for articles (2018 – 2021) about patients with elective/urgent/emergent aortic requiring a proximal landing zone in the aortic arch (zone 0 – 1 – 2) and treated by f/b-TEVAR.
REVIEW METHODS: Systematic review and meta-analysis were performed according to the PRISMA guidelines. Open repair, supra-aortic trunk (SAT) debranching + standard TEVAR, and in situ/physician modified/parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up.
RESULTS: Out of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). f-TEVAR, b-TEVAR, and f + b-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 – 0.97; I2 = 0%; p for heterogeneity (Het) = .77) and 30 day mortality was 6.7% (95% CI 0.05 – 0.09; I2 = 0%; p Het = .66). No statistical differences were found comparing fenestrated vs. branched endografts, except for a higher rate of type I – III endoleaks in f-TEVAR (9.8% vs 2.6%; p = .034). Overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 – 96.4% and 94 – 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively.
CONCLUSION: f/b-TEVAR for the treatment of the aortic arch, nowadays show, according to experience in dedicated centres, a satisfactory level of technical success together with progressive lowered load in terms of early mortality. There are of several limitations, and further studies are needed to reach clearer conclusions.
PMID:37536517 | DOI:10.1016/j.ejvs.2023.07.048
