体外预开窗技术重建左锁骨下动脉Meta分析

Extracorporeal fenestration technique for reconstruction of left subclavian artery:a meta-analysis

目的 系统评价应用体外预开窗技术治疗胸主动脉病变,重建主动脉弓上左锁骨下动脉的安全性及有效性。方法 通过数据库进行文献检索,以确定2016年1月至2021年12月期间应用体外预开窗技术腔内修复主动脉弓部病变,同时保留弓上分支血管血供的文献。研究条件需要符合:临床研究,研究纳入病人≥20例,全文可获得。回顾性分析技术成功率、内漏发生率、并发症发生率及病死率等临床结果。结果 共纳入7篇文献,356例病人,技术成功率98%(95%CI 97%~99%;P=0.76),平均随访时间为22.8个月,共25例病人出现术后支架内漏(Ⅰ型内漏16例,Ⅱ型内漏2例,Ⅲ型内漏7例),30 d手术并发症发生率和随访期手术相关并发症发生率分别为11%(95%CI 7%~14%;P=0.46)及4%(95%CI 1%~9%;P=0.01)。结论 应用体外预开窗技术重建左锁骨下动脉技术成功率高,并发症发生率及技术相关病死率较低。

Objective To evaluate the safety and effectiveness of the "extracorporeal fenestration " technique for reconstruction of the left subclavian artery vessel in the treatment of aortic arch pathologies.Methods A search was conducted through the database to identify the articles on endovascular repair of aortic arch lesions using the "extracorporeal fenestration" technique from January 2016 to December 2021,while preserving the blood supply of the vessels above the arch.The research conditions need to meet:clinical research,with ≥20 patients included in the study,and the full text is available.The short-term and mid-term clinical outcomes,such as technical success rate,endoleak rate,complication rate,and fatality rate were retrospectively analyzed.Results A total of 356 patients from 7 articles were included,the technical success rate was 98%(95%CI 97%~99%;P=0.76),and the mean follow-up time was 22.8 months.A total of25 patients had postoperative stent leakage(There were 16 cases of type Ⅰ endoleak,2 cases of type Ⅱ endoleak,and 7cases of type Ⅲ endoleak).The 30-day operative complication rates and the operative-related complication rates during the follow-up were 11%(95%CI 7%~14%;P=0.46) and 4%(95%CI 1%~9%;P=0.01),respectively.Conclusion The use of the "external fenestration" technique to reconstruct the left subclavian artery on the arch has a high success rate,low complication,and mortality rate.