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

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.

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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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