腹主动脉瘤腔内隔绝术后经动脉栓塞与经腰栓塞治疗Ⅱ型内漏效果对比的meta分析

doi:10.24920/003618

摘要/Abstract

摘要： 目的 Ⅱ型内漏是腹主动脉瘤腔内隔绝术后最常见的内漏类型,常用栓塞方式包括经动脉栓塞和经腰栓塞,但目前哪种栓塞方式的治疗效果更佳仍存在争议。本文采用Meta分析对比经动脉栓塞和经腰栓塞腹主动脉瘤腔内隔绝术后Ⅱ型内漏的治疗效果。方法本研究方案已于Prospero网站注册（CRD 42018114453）。文献检索数据库包括Pubmed,Embase,Web of Science和Cochrane,最后一次检索时间为2019年3月。检索关键词包括腹主动脉瘤腔内隔绝术、Ⅱ型内漏、经动脉栓塞及经腰栓塞。所有对比经动脉栓塞和经腰栓塞治疗效果的随机对照或回顾性研究均纳入本研究中。由两位作者独立完成文章阅读及数据提取,使用随机效应模型分析数据结果。结果共有6篇文章纳入研究,均为回顾性研究,包括268名患者和290个Ⅱ型内漏病变。经动脉栓塞和经腰栓塞相比,技术成功率OR=0.56（95% CI：0.10-3.18;P=0.51）,临床成功率OR=0.31（95% CI：0.07-1.29;P=0.11）。结果对于Ⅱ型内漏的治疗,经动脉栓塞和经腰栓塞均具有良好的治疗效果,在技术成功率和临床成功率两方面均无统计学差异。优于所纳入文章较少且为回顾性研究,可能导致结果偏倚,需要开展高质量临床试验进一步研究两种治疗方式的效果。

关键词: Ⅱ型内漏;, 经动脉栓塞, 经腰栓塞, 腹主动脉瘤腔内隔绝术

Abstract: Objective Type Ⅱ endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair (EVAR). The efficacy of transarterial (TA) embolization and translumber (TL) embolization in the management of type Ⅱ endoleak remains equipoise. The aim of this study is to compare the technical and clinical success between TA embolization and TL embolization for type Ⅱ endoleak after EVAR.Methods The protocol was registered (CRD 42018114453) and the electronic databases (Pubmed, Embase, Web of Science, and Cochrane) were systematically searched till March 2019. The search terms included EVAR, type Ⅱ endoleak, and embolization. The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type Ⅱ endoleak after EVAR. The technical and clinical success rates were meta-analyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type Ⅱ endoleaks were included. The pooled odds ratio (OR) of technical success rate for TA vs. TL was 0.56 (95% CI, 0.10-3.18; P=0.51) and the pooled OR of clinical success rate for TA vs. TL was 0.31(95% CI, 0.07-1.29; P=0.11). As a limitation, 6 articles were all retrospective studies which may lead to bias.Conclusion Both TA and TL could be effective procedure of embolizations to resolve the type Ⅱ endoleak. The meta-analysis result indicated that TA embolization was not inferior to TL embolization in technical success and clinical success.

Key words: endoleak, endovascular aneurysm repair, embolization, abdominal aortic aneurysm, meta-analysis

Zhang Xu,Ji Lei,Chen Mengyin,Wang Wei,Zheng Yuehong. Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdominal Aortic Aneurysm Repair: A Meta-Analysis[J].Chinese Medical Sciences Journal, 2020, 35(2): 135-141.

图/表 4

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Studies	Country	Research type	Criteria for intervention	No. of patients	No. of endoleaks	TA		TL		Materials	Follow-up
Studies	Country	Research type	Criteria for intervention	No. of patients	No. of endoleaks	Technical success	Clinical success	Technical success	Clinical success	Materials	Follow-up
Marcelin et al., 2017 ^[30]	France	Retrospective study	Persistent after 6 months and increasing sac size > 5 mm	28	29	16/22 (72.7%)	NS	1/7 (14.3%)	NS	onyx	20 ± 12 months (range 6 - 49 months)
Haq et al., 2017 ^[31]	UK	Retrospective study	Increasing sac size > 5 mm	28	28	7/17 (41.2%)	2/17 (11.8%)	3/11 (27.3%)	3/11 (27.3%)	coils or embolizing agent	3.11 years (median)
Massis et al., 2012 ^[32]	USA	Retrospective study	Increase of sac size > 5 mm within 6 month, or sac > 6 cm or change in sac morphology, or change in position or orientation of stent graft in sac	95	101	58/65 (89.2%)	21/29 (72.4%)	36/36 (100%)	18/24 (75%)	onyx	15 weeks
Nevala et al., 2010 ^[33]	Finland	Retrospective study	Increasing sac size or persistent after 3 months	14	14	4/10 (40%)	2/9 (22.2%)	3/3 (100%)	3/3 (100%)	coils, thrombin, gelatin, onyx, glue	NS
Stavropoulos et al., 2009 ^[29]	USA	Retrospective study	Persistent > 1 month and aneurysm expansion	84	85	22/23 (95.7%)	18/23 (78.3%)	62/62 (100%)	45/62 (72.6%)	coils, n-butyl cyanoacrylate	18.7 months (range 1-84 months)
Baum et al., 2002 ^[34]	USA	Retrospective study	Persistent >1 month	19	33	17/20 (85%)	4/20 (20%)	13/13 (100%)	12/13 (92.3%)	coils, thrombin	13.1/8.4 months

Studies	Adequate case definition	Represen- tativeness	Selection of controls	Definition of controls	Compara- bility	Ascertainment of exposure	Same method of ascertainment	Non-Response rate	Total score
Marcelin et al., 2017^[30]	★	★	n/a	★	n/a	★	★	n/a	5
Haq et al., 2017^[31]	★	★	n/a	★	★	★	★	n/a	6
Massis et al., 2012^[32]	★	★	n/a	★	n/a	★	★	n/a	5
Nevala et al., 2010^[33]	★	★	n/a	★	n/a	★	★	n/a	5
Stavropoulos et al., 2009^[29]	★	★	n/a	★	★	★	★	n/a	6
Baum et al., 2002^[34]	★	★	n/a	★	★	★	★	n/a	6

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