Background
To conduct a network meta-analysis comparing multiple treatments for complex aortic
aneurysms (CAAs).
Methods
Medical databases were searched on November 11, 2022. Twenty-five studies (5,149 patients)
and four treatments (open surgery [OS], chimney/snorkel endovascular aneurysm repair
[CEVAR], fenestrated endovascular aneurysm repair [FEVAR], and branched endovascular
aneurysm repair) were selected. Outcomes were branch vessel patency, mortality, and
reintervention at short- and long-term followup, and perioperative complications.
Results
Regarding branch vessel patency, OS was the most effective treatment and had higher
24-month branch vessel patency rates than CEVAR (odds ratio [OR], 10.77; 95% confidence
interval [CI], 2.08–55.79). FEVAR (OR, 0.52; 95% CI, 0.27–1.00) and OS (OR, 0.39;
95% CI, 0.17–0.93) were better than CEVAR regarding 30-day mortality and 24-month
mortality, respectively. Regarding 24-month reintervention, OS was better than CEVAR
(OR, 3.07; 95% CI, 1.15–8.18) and FEVAR (OR, 2.48; 95% CI, 1.08–5.73). Regarding perioperative
complications, FEVAR had lower acute renal failure rates than OS (OR, 0.42; 95% CI,
0.27–0.66) and CEVAR (OR, 0.47; 95% CI, 0.25–0.92) and lower myocardial infarction
rates than OS (OR, 0.49; 95% CI, 0.25–0.97) and was the most effective treatment in
preventing acute renal failure, myocardial infarction, bowel ischemia, and stroke,
while OS was the most effective treatment in preventing spinal cord ischemia.
Conclusions
OS might have advantages regarding branch vessel patency, 24-month mortality, and
reintervention and is similar to FEVAR regarding 30-day mortality. Regarding perioperative
complications, FEVAR might confer advantages in preventing acute renal failure, myocardial
infarction, bowel ischemia, and stroke, and OS in preventing spinal cord ischemia.
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Article info
Publication history
Published online: February 28, 2023
Accepted:
February 19,
2023
Received in revised form:
January 28,
2023
Received:
August 9,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Author contributions: Conception or design of the work: C. S. and Y. Z. Data collection: Y. Z. and J. W. Data analysis and interpretation: Y. Z., J. W. and H. H. Drafting the article: M. L. and X. L Critical revision of the article: Q. L. and C. S. Final approval of the version to be published: All authors.
Funding: This study was supported by grants from Beijing Municipal Science & Technology Commission (No. D171100002917004), National Natural Science Foundation of China (No. 81870345) and Chinese Academy of Medical Sciences Initiative for Innovative Medicine (No. 2016-I2M-1-016).
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