Two Decades of Endovascular Repair of Popliteal Artery Aneurysm--A Meta-analysis
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Two Decades of Endovascular Repair of Popliteal Artery Aneurysm--A Meta-analysis. / von Stumm, M; Teufelsbauer, H; Reichenspurner, H; Debus, E S.
in: EUR J VASC ENDOVASC, Jahrgang 50, Nr. 3, 09.2015, S. 351-359.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Two Decades of Endovascular Repair of Popliteal Artery Aneurysm--A Meta-analysis
AU - von Stumm, M
AU - Teufelsbauer, H
AU - Reichenspurner, H
AU - Debus, E S
N1 - Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
PY - 2015/9
Y1 - 2015/9
N2 - OBJECTIVE/BACKGROUND: Over the last two decades endovascular repair (EVR) of popliteal artery aneurysms has emerged as a treatment alternative to conventional open surgical repair (OSR). The aim of this review was to evaluate the safety and efficiency of each repair method, comparing the following outcomes after EVR and OSR: (i) primary patency; (ii) operating time; (iii) length of hospital stay; (iv) peri-operative complications; (v) limb salvage; and (vi) patient survival.METHODS: The PubMed and Cochrane Central Register of Controlled Trials were searched for publications that compared outcomes after EVR and OSR (last search November 2014). Randomized controlled trials (RCTs), prospective and retrospective observational cohort studies were included. The quality of studies was evaluated using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random effect models were employed to estimate odds ratios (ORs), mean differences, and hazard ratios (HRs).RESULTS: One RCT combined with a prospective cohort study and four retrospective cohort studies with an overall total of 652 cases (236 EVR, 416 OSR) were identified. GRADE quality of evidence was low or very low for all outcomes. After a median follow up of 33 months, patients who received EVR showed equal primary patency rates to patients who received OSR (HR 1.46, 95% confidence interval [CI] 0.92-2.33). Lengths of operation and hospitalization were significantly shorter following EVR; rates of 30 day graft thrombosis (OR 3.16, 95% CI 1.31-7.62) and 30 day re-intervention (OR 2.15, 95% CI 1.02-4.55) were significant higher for patients who received EVR compared with those who received OSR. There was no effect on mortality (OR 2.31, 95% CI 0.37-14.49) or limb loss (OR 0.59, 95% CI 0.16-2.15).CONCLUSION: EVR of popliteal artery aneurysm showed mid-term results comparable to open surgery and appears to be a safe alternative to OSR. However, the existing empirical evidence base is too fragmentary to draw firm conclusions. Further research and the introduction of population based registries will be needed to allow reliable evaluation of EVR.
AB - OBJECTIVE/BACKGROUND: Over the last two decades endovascular repair (EVR) of popliteal artery aneurysms has emerged as a treatment alternative to conventional open surgical repair (OSR). The aim of this review was to evaluate the safety and efficiency of each repair method, comparing the following outcomes after EVR and OSR: (i) primary patency; (ii) operating time; (iii) length of hospital stay; (iv) peri-operative complications; (v) limb salvage; and (vi) patient survival.METHODS: The PubMed and Cochrane Central Register of Controlled Trials were searched for publications that compared outcomes after EVR and OSR (last search November 2014). Randomized controlled trials (RCTs), prospective and retrospective observational cohort studies were included. The quality of studies was evaluated using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random effect models were employed to estimate odds ratios (ORs), mean differences, and hazard ratios (HRs).RESULTS: One RCT combined with a prospective cohort study and four retrospective cohort studies with an overall total of 652 cases (236 EVR, 416 OSR) were identified. GRADE quality of evidence was low or very low for all outcomes. After a median follow up of 33 months, patients who received EVR showed equal primary patency rates to patients who received OSR (HR 1.46, 95% confidence interval [CI] 0.92-2.33). Lengths of operation and hospitalization were significantly shorter following EVR; rates of 30 day graft thrombosis (OR 3.16, 95% CI 1.31-7.62) and 30 day re-intervention (OR 2.15, 95% CI 1.02-4.55) were significant higher for patients who received EVR compared with those who received OSR. There was no effect on mortality (OR 2.31, 95% CI 0.37-14.49) or limb loss (OR 0.59, 95% CI 0.16-2.15).CONCLUSION: EVR of popliteal artery aneurysm showed mid-term results comparable to open surgery and appears to be a safe alternative to OSR. However, the existing empirical evidence base is too fragmentary to draw firm conclusions. Further research and the introduction of population based registries will be needed to allow reliable evaluation of EVR.
KW - Aged
KW - Aged, 80 and over
KW - Amputation
KW - Aneurysm/diagnosis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Chi-Square Distribution
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Limb Salvage
KW - Male
KW - Middle Aged
KW - Odds Ratio
KW - Popliteal Artery/physiopathology
KW - Postoperative Complications/mortality
KW - Reoperation
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Vascular Patency
U2 - 10.1016/j.ejvs.2015.04.036
DO - 10.1016/j.ejvs.2015.04.036
M3 - SCORING: Review article
C2 - 26138062
VL - 50
SP - 351
EP - 359
JO - EUR J VASC ENDOVASC
JF - EUR J VASC ENDOVASC
SN - 1078-5884
IS - 3
ER -