| Objective:We reviewed the literature examining the endograft fixation for infra-renal abdominal aortic aneurysm repair and completed a comparative analysis of the patient outcomes.Methods:A systematic literature search was performed in August 2017using PubMed/MEDLINE,EMBASE,the Cochrane Library,CBMdisc,CNKI,VIP,and Wanfang Med Online databases were searched for entries 7published between January 1,1983 and August 1,2017yielding 1528relevant articles,one of the Chinese literature is 0 relevant articles.All studies which met inclusion criteria related to the clinical outcomes following endovascular repair(EVAR)for abdominal aortic aneurysm(AAA)treatment in suprarenal fixation compared with infra-renal treatment to perform a pooled analysis.Patient demographics,comorbidities,operative details,and outcomes were compared.Our main endpoints were the risk of renal insufficiency,postoperative mortality and endoleaks.The quality of individual studies were evaluated using the Newcastle-Ottawa criteria.We reviewed pooled data using a random-effects meta-analysis.Results:Twenty observational studies(representing data from 55,296participants)were identified in a search of published literature.The suprarenal group were observed to have a higher comorbidity rate in patients after EVAR,20 with a statistically significant different occurrence of coronary artery disease(OR:1.16,95%confidence interval1.09-1.24,P<0.00001).The incidence of diabetes between the two groups was different(OR:1.07,95%confidence interval 1.01-1.12,P=0.01).The meta-analysis demonstrated that the pooled relative ratio for deterioration of renal function after suprarenal fixation was 1.25,in the pooled analysis(95%confidence interval 1.09–1.44;P=0.001),with evidence of heterogeneity(I~2=23%)and publication bias(Egger P=0.795),this represents moderate heterogeneity.A review of post-operative mortality included five studies(15,196 patients in the suprarenal group,11,076 patients in infra-renal group).The average number of stars using the Newcastle-Ottawa Scale(NOS)was a maximum of 9 stars.The NOS for Assessing the Quality of Nonrandomized Studies was used to evaluate the data quality for each study;the results are show in Table I scores ranged from 6–9.The overall pooled estimate of post-operative mortality for EVAR was higher in the suprarenal fixation than in the infra-renal group(RR 1·37,95%CI 1·17–1.61,P<0.0001).This effect was consistent in the subgroup analysis during a one year patient follow-up period and maintained significance in early renal impairment.Type I endoleak incidence was described in 3 studies,this parameter showed no statistical significant difference between the two treatment groups(I~2=25%,RR:1.39,95%CI:0.89–2.17,P=0.15).The risk of prolonged length of stay(>2days)were more common in suprarenal stent patients(RR:1.44,95%CI:1.25–1.65;P<0.00001).It is imperative to mention that the results of these particular studies reflect only early and mid-term outcomes.Conclusion:This meta-analysis demonstrated that patients with suprarenal stent grafts have an increased likelihood of renal complications,which remained significantly one year after EVAR. |
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