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Comparative Effectiveness of Treatment Modalities for Complex Aortic Aneurysms: A Network Meta-Analysis of

Yang Zhou1, Junwei Wang1, Hao He1

  • 1Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Vascular Disease Institute of Central South University, Changsha, Hunan, China.

Annals of Vascular Surgery
|March 3, 2023
PubMed
Abstract

Insights

Open surgery (OS) shows superior outcomes for complex aortic aneurysms (CAAs) in branch vessel patency, mortality, and reintervention. Fenestrated endovascular aneurysm repair (FEVAR) excels in preventing perioperative complications like renal failure and myocardial infarction.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Technology

Background:

  • Complex aortic aneurysms (CAAs) present significant treatment challenges.
  • Evaluating the comparative effectiveness of different repair strategies is crucial for patient outcomes.

Purpose of the Study:

  • To conduct a network meta-analysis comparing open surgery (OS), chimney/snorkel endovascular aneurysm repair (CEVAR), fenestrated endovascular aneurysm repair (FEVAR), and branched endovascular aneurysm repair for CAAs.
  • To assess treatment efficacy regarding branch vessel patency, mortality, reintervention, and perioperative complications.

Main Methods:

  • A systematic search of medical databases was performed on November 11, 2022.
  • Twenty-five studies involving 5,149 patients were included, comparing OS, CEVAR, FEVAR, and branched endovascular aneurysm repair.
  • Outcomes analyzed included short- and long-term branch vessel patency, mortality, reintervention rates, and perioperative complications.

Main Results:

  • Open surgery demonstrated superior 24-month branch vessel patency compared to CEVAR.
  • FEVAR and OS showed lower 30-day and 24-month mortality, respectively, compared to CEVAR.
  • OS was associated with better 24-month reintervention rates than CEVAR and FEVAR.
  • FEVAR exhibited lower rates of acute renal failure and myocardial infarction than OS and CEVAR.
  • FEVAR was most effective in preventing acute renal failure, myocardial infarction, bowel ischemia, and stroke; OS was most effective for spinal cord ischemia.

Conclusions:

  • Open surgery may offer advantages in branch vessel patency, 24-month mortality, and reintervention for CAAs.
  • FEVAR demonstrates significant benefits in reducing perioperative complications, including acute renal failure, myocardial infarction, bowel ischemia, and stroke.
  • Both OS and FEVAR show comparable 30-day mortality rates.
  • Open surgery remains superior in preventing spinal cord ischemia.

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