Objective

To investigate whether patients with severe infrarenal aortic neck angulation have worse outcomes than those without severe angulation after endovascular aneurysm repair (EVAR).

Data sources

The HDAS (Healthcare Database Advanced Search) interface developed by NICE (National Institute for Health and Care Excellence) was used to search electronic bibliographic databases.

Review methods

Studies comparing outcomes of standard EVAR in patients with and without severe neck angulation were considered. Pooled outcome estimates were calculated using the odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI), using the Mantel–Haenszel or inverse variance method, as appropriate. Random effects models of meta-analysis were applied. The GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) methodology was used to assess the certainty of evidence.

Results

Ten studies reporting a total of 7 371 patients (1 576 with severe neck angulation and 5 795 without) were included. The studies reported medium term follow up. No statistically significant difference was found for the primary outcomes (overall mortality: HR 1.27, 95% CI 0.88 – 1.85, low certainty; aneurysm related mortality: HR 1.07, 95% CI 0.80 – 1.44, moderate certainty; aneurysm rupture: HR 1.41, 95% CI 0.66 – 2.99, low certainty). The hazard of type Ia endoleak (HR 1.86, 95% CI 1.32 – 2.61) and re-intervention was higher in patient with severe angulation (HR 1.24, 95% CI 1.01 – 1.54), but there was no significant difference in the odds of adjunctive procedures (OR 1.23, 95% CI 0.48 – 3.11), or the hazard of sac expansion (HR 0.83, 95% CI 0.44 – 1.55) or stent migration (HR 1.22, 95% CI 0.78 – 1.92). Meta-analysis of studies that conducted multiple Cox regression analysis showed no significant difference for any of the primary outcomes.

Conclusion

Severe neck angulation may not be a poor prognostic indicator for overall/aneurysm related mortality and rupture in the medium term after EVAR but may increase the risk of late type 1 endoleaks and re-intervention; therefore, patients require close surveillance.

中文翻译：

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严重肾下主动脉颈成角在血管内动脉瘤修复中的预后作用

客观的

旨在调查在血管内动脉瘤修复 (EVAR) 后，严重肾下主动脉颈成角患者的预后是否比没有严重成角的患者更差。

数据源

NICE（国家健康与保健卓越研究所）开发的 HDAS（医疗保健数据库高级搜索）界面用于搜索电子书目数据库。

复习方法

研究比较了标准 EVAR 在有和没有严重颈部成角的患者中的结果。使用比值比 (OR) 或风险比 (HR) 和 95% 置信区间 (CI) 计算汇总结果估计值，并酌情使用 Mantel-Haenszel 或逆方差方法。应用荟萃分析的随机效应模型。GRADE（推荐分级、评估、制定和评估）方法用于评估证据的确定性。

结果

10 项研究共纳入了 7 371 名患者（1 576 名有严重的颈部成角，5 795 名没有）。这些研究报告了中期随访。主要结局没有发现统计学显着差异（总死亡率：HR 1.27，95% CI 0.88 – 1.85，低确定性；动脉瘤相关死亡率：HR 1.07，95% CI 0.80 – 1.44，中等确定性；动脉瘤破裂：HR 1.41， 95% CI 0.66 – 2.99，低确定性）。Ia 型内漏 (HR 1.86, 95% CI 1.32 – 2.61) 和再次干预的风险在严重成角的患者中更高 (HR 1.24, 95% CI 1.01 – 1.54)，但发生几率没有显着差异辅助手术（OR 1.23，95% CI 0.48 – 3.11），或囊扩张的危险（HR 0.83，95% CI 0.44 – 1.55）或支架移位（HR 1.22，95% CI 0.78 – 1.92）。

结论

严重的颈部成角可能不是 EVAR 后中期整体/动脉瘤相关死亡率和破裂的不良预后指标，但可能会增加晚期 1 型内漏和再次干预的风险；因此，患者需要密切监测。