Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results
Abstract
:1. Introduction
2. Methods
2.1. Screening and Study Selection
2.2. Data Extraction and Definitions
2.3. Outcomes Measures
2.4. Quality Assessment
2.5. Statistical Analysis
3. Results
3.1. Study Characteristics
3.2. Quality of Included Studies and Choice of Model
3.3. Primary Outcomes
3.4. Secondary Outcomes
4. Discussion
5. Limitations and Implications for Research
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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First Author (Year of Publication) | Study Design | AAA Type | Follow-Up Duration (Months) | Intervention | Sample Size | Mean AGE (years) | Female Gender (%) | Smoking (%) | HTN (%) | HLP (%) | Diabetes (%) | COPD (%) | CAD (%) | CVD (%) | CKD (%) | AAA Size (mm) | Previous Aortic Intervention |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Donas et al. (2012) [17] | Retrospective observational | Juxtarenal | 14.2 | ChEVAR | 30 | 74 | 10 | - | - | - | - | 33.3 | 33.3 | - | 23.3 | 62 | 11 |
FEVAR | 29 | 73 | 0 | - | - | - | - | 27.9 | 41.4 | - | 17.2 | 65 | 8 | ||||
Open surgery | 31 | 71 | 12.9 | - | - | - | - | 19.3 | 12.9 | - | 6.4 | 60 | 2 | ||||
Wei et al. (2013) [18] | Retrospective observational | Juxtarenal | 12 | ChEVAR | 37 | - | - | - | - | - | - | - | - | - | - | - | - |
FEVAR | 13 | - | - | - | - | - | - | - | - | - | - | - | - | ||||
Lee et al. (2014) [19] | Retrospective observational | Juxtarenal | 6 | ChEVAR | 15 | 76 | 26.6 | 93.3 | 100 | - | 6.6 | 33.3 | - | - | - | 66 | - |
FEVAR | 15 | 77 | 33.3 | 73.3 | 93.3 | - | 33.3 | 13.3 | - | - | - | 61 | - | ||||
Barilla et al. (2014) [20] | Retrospective observational | Juxtarenal | 60 | Open surgery | 50 | 78 | 6 | 16 | 75 | 56 | 22 | 44 | 54 | 8 | 20 | - | - |
FEVAR | 50 | 71 | 4 | 22 | 75 | 50 | 24 | 48 | 58 | 6 | 16 | - | - | ||||
Banno et al. (2014) [21] | Retrospective observational | Juxta/pararenal | 24 | FEVAR | 80 | 74 | 10 | - | 70 | 51 | 17.5 | 32.5 | 55 | 16.2 | 15 | 58 | 4 |
ChEVAR | 38 | 74 | 10.5 | - | 79 | 58 | 26.3 | 29 | 39.5 | 10.5 | 23.7 | 66 | 9 | ||||
Shahverdyan et al. (2015) [22] | Retrospective observational | Juxtarenal | 24 | Open surgery | 34 | 72 | 23.5 | - | 76.5 | - | 14.7 | 38.2 | 53 | - | 5.9 | - | - |
FEVAR | 35 | 72 | 14.3 | - | 85.7 | - | 5.7 | 20 | 45.7 | - | 11.4 | - | - | ||||
Saratzis et al. (2015) [23] | Retrospective observational | Juxtarenal | 20 | FEVAR | 58 | 75 | 12 | 81 | 63.8 | 67.2 | 31 | - | 31 | 8.6 | - | 52 | |
Open surgery | 58 | 74 | 12 | 81 | 63.8 | 67.2 | 31 | - | 25.4 | 8.6 | - | 53 | - | ||||
Maeda et al. (2015) [24] | Retrospective observational | Juxtarenal | 33 | Open surgery | 81 | 71 | 14.8 | 72.8 | 74.1 | 40.7 | 24.7 | 23.4 | 54.3 | 24.7 | 22.2 | 58 | - |
FEVAR | 34 | 77 | 11.7 | 58.8 | 82.3 | 50 | 17.6 | 20.6 | 26.5 | 20.6 | 23.5 | 55 | - | ||||
ChEVAR | 37 | 77 | 10.8 | 59.4 | 81.1 | 48.6 | 18.9 | 21.6 | 27 | 18.9 | 21.6 | 56 | - | ||||
Wooster et al. (2016) [25] | Retrospective observational | Juxtarenal | 15 | ChEVAR | 54 | 78 | 11.5 | 87 | 87 | 70.3 | 20.4 | 31.5 | 63 | 9.2 | - | 62 | - |
FEVAR | 39 | 72 | 12.8 | 79.5 | 82 | 66.6 | 15.4 | 38.5 | 53.8 | 17.9 | - | 68 | - | ||||
Caradu et al. (2017) [26] | Retrospective observational | Juxtarenal | 24 | FEVAR | 90 | 71 | 2.2 | 70 | 80 | 61.1 | 12.2 | 26.6 | - | 10 | 14.4 | 58 | - |
ChEVAR | 31 | 75 | 16.1 | 67.7 | 77.4 | 67.7 | 9.7 | 35.5 | - | 6.4 | 38.7 | 67 | - | ||||
Fiorucci et al. (2018) [27] | Retrospective observational | Pararenal | 50 | FEVAR | 92 | 75 | 9.8 | - | 84.8 | 32.6 | 11.9 | 41.3 | 57.6 | 10.8 | 18.5 | - | - |
Open surgery | 108 | 70 | 5.5 | - | 88.9 | 39.8 | 14.8 | 51.8 | 30.5 | 1 | 30.5 | - | - | ||||
Chinsakchai et al. (2019) [28] | Retrospective observational | Juxtarenal | 37 | Open surgery | 32 | 70 | 21.9 | 15.6 | 81.2 | 46.9 | 15.6 | 3.1 | 46.9 | 63 | - | ||
FEVAR | 20 | 72 | 15 | 15 | 85 | 15 | 20 | 15 | 30 | 55 | - | ||||||
ChEVAR | 23 | 76 | 34.8 | 4.3 | 65.2 | 30.4 | 8.7 | 8.7 | 30.4 | 68 | - | ||||||
Soler et al. (2019) [29] | Retrospective observational | Juxtarenal | 27 | Open surgery | 134 | 69 | 7.4 | 86.5 | 67.9 | 61.2 | 14.2 | 33.6 | 40.3 | - | 20.9 | 59 | 5 |
FEVAR | 57 | 74 | 5.2 | 84.2 | 78.9 | 59.6 | 12.3 | 56.1 | 49.1 | - | 22.8 | 55 | 9 | ||||
O’Donnell et al. (2020) [30] | Retrospective observational | Juxtarenal | 36 | Open surgery | 1894 | 70 | 21 | 47 | 85 | - | 16 | 33 | 37 | - | 34 | - | 0 |
FEVAR | 822 | 73 | 20 | 34 | 86 | - | 19 | 38 | 45 | - | 42 | - | 6 | ||||
Menegolo et al. (2021) [31] | Retrospective observational | Juxtarenal | 43 | ChEVAR | 25 | 77 | 28 | - | 100 | - | 25 | 32 | 40 | - | 40 | 67 | 8 |
Open surgery | 61 | 71 | 3.3 | - | 82 | - | 14.7 | 9.8 | 29.5 | - | 22.9 | 65 | 0 | ||||
Bootun et al. (2021) [32] | Retrospective observational | Juxtarenal | 60 | Open surgery | 98 | 74 | 19 | - | 19.4 | - | 11.2 | 22.4 | 32.6 | 4.1 | 16.3 | 67 | - |
FEVAR | 64 | 76 | 4 | - | 6.2 | - | 9.4 | 25 | 45.3 | 20.3 | 18.7 | 76 | - |
First Author (Year of Publication) | AAA Type | Intervention | Sample Size | Stent Graft Manufacturer | Chimney/Bridging Stent Graft Manufacturer | FEVAR/ChEVAR Configuration | Open Surgery | Operation Duration (min) | Blood Loss (ml) | ICU Stay (Days) | Hospital Stay (Days) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
One Fenestration/One Chimney | Two Fenestrations/Two Chimneys | Three Fenestrations/One Chimneys | Four Fenestrations/One Chimneys | Mean Number of Fenestrations/Chimneys | Infrarenal Clamp | Interrenal Clamp | Suprarenal Clamp | Supraceliac Clamp | Mean Proximal Clamp Duration (min) | ||||||||||
Donas et al. (2012) [17] | Juxtarenal AAA | Chimney EVAR | 30 | Medtronic | Advanta balloon expandable | 22 | 5 | 3 | 0 | 1.4 | - | - | - | - | - | 90 | - | - | 3 |
FEVAR | 29 | Cook Zenith | - | 0 | 29 | 0 | 0 | 2 | - | - | - | - | - | 290 | - | - | 3 | ||
Open surgery | 31 | - | - | - | - | - | - | - | - | - | - | - | 23 | - | - | - | 7 | ||
Wei et al. (2013) [18] | Juxtarenal AAA | Chimney EVAR | 37 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
FEVAR | 13 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | ||
Lee et al. (2014) [19] | Juxtarenal AAA | Chimney EVAR | 15 | Medtronic/Gore/Cook Zenith | iCAST and Viabahn | - | - | - | - | - | - | - | - | - | - | 218 | 400 | 1 | 4 |
FEVAR | 15 | Cook Zenith | iCAST | - | - | - | - | - | - | - | - | - | - | 282 | 650 | 1 | 4 | ||
Barilla et al. (2014) [20] | Juxtarenal AAA | Open surgery | 50 | - | - | - | - | - | - | - | 35 | - | 15 | 0 | 48 | - | - | 5 | 12 |
FEVAR | 50 | - | - | 2 | 48 | 0 | 0 | 1.9 | - | - | - | - | - | - | - | 3 | 12 | ||
Banno et al. (2014) [21] | Juxta/pararenal AAA | FEVAR | 60 | Cook Zenith, Anaconda | BECSs: Advanta V12 Fluency | 3 | 44 | 29 | 4 | 2.4 | - | - | - | - | - | 191 | - | - | 8 |
Chimney EVAR | 38 | - | BECSs, Advanta V12 Fulency | 20 | 14 | 4 | 0 | 1.6 | - | - | - | - | - | 183 | - | - | 2 | ||
Shahverdyan et al. (2015) [22] | Juxtarenal AAA | Open surgery | 34 | - | - | - | - | - | - | - | 0 | 15 | 14 | 5 | - | 171 | - | - | 11 |
FEVAR | 35 | Cook Zenith, Anaconda | Advanta V12 | 2 | 19 | 11 | 3 | 2.3 | - | - | - | - | - | 188 | - | - | 7 | ||
Saratzis et al. (2016) [23] | Juxtarenal AAA | FEVAR | 58 | Cook Zenith | - | 3 | 23 | 27 | 5 | 2.6 | - | - | - | - | - | - | - | - | 6 |
Open surgery | 58 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 7 | ||
Maeda et al. (2016) [24] | Juxtarenal AAA | Open surgery | 81 | - | - | - | - | - | - | - | 0 | 28 | 47 | 6 | 35 | 313 | 3120 | - | 15 |
FEVAR | 34 | Cook Zenith | Advanta V12 | - | - | - | - | - | - | - | - | - | - | 282 | 550 | - | 8 | ||
Chimney EVAR | 37 | Gore Excluder | Advanta V12 | - | - | - | - | - | - | - | - | - | - | 198 | 440 | - | 8 | ||
Wooster et al. (2016) [25] | Juxtarenal AAA | Chimney EVAR | 54 | Medtronic, Gore Excluder, Cook Zenith | - | 27 | 21 | 4 | 2 | 1.6 | - | - | - | - | - | 233 | 634 | 2 | 6 |
FEVAR | 39 | Cook Zenith | - | 1 | 16 | 21 | 1 | 2.5 | - | - | - | - | - | 238 | 408 | 2 | 6 | ||
Caradu et al. (2017) [26] | Juxtarenal AAA | FEVAR | 90 | Cook Zenith, Anaconda | Advanta 12 | 0 | 72 | 14 | 4 | 2.2 | - | - | - | - | - | 182 | - | 1 | 7 |
Chimney EVAR | 31 | Cook Zenith, Medtronic | Fluency | - | - | - | - | 1.3 | - | - | - | - | - | 139 | - | 1 | 7 | ||
Fiorucci et al. (2018) [27] | Pararenal AAA | FEVAR | 92 | Cook Zenith | - | 8 | 30 | 29 | 25 | 2.8 | - | - | - | - | - | 218 | 344 | - | 10 |
Open surgery | 108 | - | - | - | - | - | - | - | - | - | - | - | - | 237 | 758 | - | 9 | ||
Chinsakchai et al. (2019) [28] | Juxtarenal AAA | Open surgery | 32 | - | - | - | - | - | - | 3 | 9 | 10 | 10 | - | 242 | - | 1 | 8 | |
FEVAR | 20 | Cook Zenith | Advanta V12 | - | - | - | - | 2.4 | - | - | - | - | - | 262 | - | 1 | 7 | ||
Chimney EVAR | 23 | - | Advanta V12, BeGraft, Viabahn | - | - | - | - | 1.8 | - | - | - | - | - | 270 | - | 1 | 9 | ||
Soler et al. (2019) [29] | Juxtarenal AAA | Open surgery | 134 | - | - | - | - | - | - | - | 0 | 10 | 91 | 33 | 23 | - | - | 1 | 11 |
FEVAR | 57 | Cook Zenith | Blue Genesis, Advanta V12 | 3 | 25 | 22 | 7 | 2.6 | - | - | - | - | - | - | - | 2 | 8 | ||
O’Donnell et al. (2020) [30] | Juxtarenal AAA | Open surgery | 1894 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
FEVAR | 822 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | ||
Menegolo M et al. (2021) [31] | Juxtarenal AAA | Chimney EVAR | 25 | Medtronic, Gore Excluder, Cook Zenith | Advanta V12, Viabahn, Fluency | 16 | 8 | 0 | 1 | 1.4 | - | - | - | - | - | 244 | - | 1 | 10 |
Open surgery | 61 | - | - | - | - | - | - | - | 0 | 28 | 21 | 12 | 22 | 214 | - | 3 | 8 | ||
Bootun et al. (2021) [32] | Juxtarenal AAA | Open surgery | 98 | - | - | - | - | - | - | - | 0 | 43 | 55 | 0 | 24 | - | 1600 | 3 | 10 |
FEVAR | 64 | - | - | 4 | 22 | 23 | 15 | 2.7 | - | - | - | - | - | - | - | 1 | 6 |
FEVAR vs. OS | ChEVAR vs. OS | ChEVAR vs. FEVAR | Heterogeneity | |
---|---|---|---|---|
Mortality | 1.53 (1.03–2.11) | 1.35 (0.74–2.40) | 0.89 (0.50–1.58) | 0.23 (0.01–0.71) |
Aortic-related reintervention | 8.32 (3.80–27.16) | 5.95 (2.23–20.18) | 0.72 (0.28–1.55) | 0.63 (0.04–1.63) |
Aortic-related mortality * | 0.65 (0.06–5.67) | 0.99 (0.07–9.76) | 1.55 (0.20–11.06) | 0.89 (0.04–1.93) |
FEVAR vs. OS | ChEVAR vs. OS | ChEVAR vs. FEVAR | Heterogeneity | |
---|---|---|---|---|
Long-term branch/bypass occlusion/stenosis | 13.13 (2.701–105.2) | 16.82 (2.79–176.7) | 1.28 (0.34–5.11) | 1.44 (0.39–1.97) |
Renal replacement therapy | 1.27 (0.13–13.87) | 1.09 (0.02–48.97) | 0.82 (0.02–32.71) | 1.43 (0.13–1.98) |
MACEs | 1.57 (0.52–5.88) | 6.96 (0.70–103.0) | 4.39 (0.49–51.21) | 0.49 (0.02–1.81) |
Total endoleaks | / | / | 1.14 (0.44–3.51) | 0.84 (0.06–1.88) |
Type I/III endoleaks | / | / | 1.59 (0.52–5.43) | 0.77 (0.05–1.88) |
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Zlatanovic, P.; Jovanovic, A.; Tripodi, P.; Davidovic, L. Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results. J. Clin. Med. 2022, 11, 6779. https://doi.org/10.3390/jcm11226779
Zlatanovic P, Jovanovic A, Tripodi P, Davidovic L. Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results. Journal of Clinical Medicine. 2022; 11(22):6779. https://doi.org/10.3390/jcm11226779
Chicago/Turabian StyleZlatanovic, Petar, Aleksa Jovanovic, Paolo Tripodi, and Lazar Davidovic. 2022. "Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results" Journal of Clinical Medicine 11, no. 22: 6779. https://doi.org/10.3390/jcm11226779