Fenestrated Endovascular Repair For Para-renal Abdominal Aortic Aneurysms:a Systematic Review And Meta-analysis

BackgroundThe development of endovascular technology has led to the introduction of fenestrated endovascular repair (f-EVAR) to treat para-renal abdominal aortic aneurysms, which had been deemed unsuitable for standard endovascular repair (EVAR). We performed a meta-analysis of data from the literature to determine the outcomes of the fenestrated technologyMethodsThe Medline, Embase, and Cochrane databases were searched to identify all studies reporting fenestrated endovascular repair of abdominal aortic aneurysms published in English between January1996and May2011. Studies were selected based on specific inclusion criteria:(1) published studies reporting f-EVAR including of greater than15cases,(2) patient demographics data and outcome data were clearly stated. Separate meta-analyses were performed for primary outcomes (30-day mortality, technical success rate, primary target vessel patency rate,12-month patency rate) and secondary outcomes (re-intervention rate, target renal artery occlusion rate, permanent dialysis rate). Subgroup analyses were performed to determine if 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 (e.g., time, patient numbers, etc)ResultsTwelve studies from2006to2011, consisting of776f-EVAR cases, were enrolled in this meta-analysis. The pooled estimate for30-day mortality was2.52%(95%CI,1.55to4.08). Technical success was measured to be92.8%(95%CI,87.5to96.0). Primary target vessel patency was98.3%(95%CI,97.4to98.8).12-month target vessel patency was94.5%(95%CI,92.1to96.2). Post-operative re-intervention rate was17.6%(95%CI,12.0to25.1). Target renal artery occlusion rate was6.1%(95%CI,4.1to8.8). Post-operative permanent dialysis rate was2.6%(95%CI,1.5to4.4). Subgroup analyses demonstrated no significant difference between major outcomes of retrospective studies and prospective studies. Regression analyses suggested large series had higher12-month target vessel patency rates compared with small series. Furthermore, as average number of fenestration increased there was a tendency of increasing30-day mortality.ConclusionsThis study demonstrates that fenestrated endovascular treatment for para-renal abdominal aortic aneurysm had acceptable early and midterm outcomes.