Fenestrated endovascular repair for pararenal abdominal aortic aneurysms: a systematic review and meta-analysis

The development of endovascular technology has led to the introduction of fenestrated endovascular repair (f-EVAR) to treat pararenal abdominal aortic aneurysms (PRAAAs) that have been deemed unsuitable for standard endovascular repair. We performed a systematic review and meta-analysis of data from the literature to determine the outcomes of the fenestrated technology.

The MEDLINE, EMBASE, and Cochrane databases were searched to identify all studies published in English between January 1996 and May 2011 that reported on f-EVAR for PRAAAs. Separate meta-analyses were performed for primary outcomes (i.e., 30-day mortality, technical success rate, primary target vessel patency rate, and 12-month patency rate) and secondary outcomes (i.e., reintervention rate, target renal artery occlusion rate, and postoperative permanent dialysis rate). Subgroup analyses were performed to determine whether there were differences in outcomes between varying types of studies (prospective or retrospective). Regression analyses were performed to explore associations between outcomes and varying factors (i.e., mid-date of study, study size, and procedure time).

Twelve studies conducted between 2006 and 2011 and consisting of a total of 776 cases of f-EVAR were enrolled. The pooled estimate for 30-day mortality was 2.52% (95% confidence interval [CI]: 1.55-4.08). Technical success was measured to be 92.8% (95% CI: 87.5-96.0). Primary target vessel patency was 98.3% (95% CI: 97.4-98.8). Twelve-month target vessel patency was 94.5% (95% CI: 92.1-96.2). The postoperative reintervention rate was 17.6% (95% CI: 12.0-25.1). The target renal artery occlusion rate was 6.1% (95% CI: 4.1-8.8). The postoperative permanent dialysis rate was 2.6% (95% CI: 1.5-4.4). Subgroup analyses found no significant differences between the major outcomes of the retrospective studies and the prospective studies. Regression analyses suggested that large series had higher 12-month target vessel patency rates than small series.

This study revealed that f-EVAR treatment for PRAAAs has acceptable early and mid-term outcomes.