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. 2022 Apr 1;4(4):CD012926.
doi: 10.1002/14651858.CD012926.pub2.

Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

Sherif Sultan  1 , Jamie Concannon  2 , Dave Veerasingam  3 , Wael Tawfick  4 , Peter McHugh  5 , Fionnuala Jordan  6 , Niamh Hynes  7
Affiliations

Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

Sherif Sultan et al. Cochrane Database Syst Rev. .

Abstract

Background: Thoracoabdominal aortic aneurysms (TAAAs) are a life-threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment options for patients, however, due to the lack of clinical trials comparing these, the optimum treatment option is unknown.

Objectives: To assess the effectiveness and safety of endovascular repair versus conventional OSR for the treatment of TAAAs.

Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.

Selection criteria: We considered all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing endovascular repair to OSR for TAAAs for inclusion in the review. The main outcomes of interest were prevention of aneurysm rupture (participants without aneurysm rupture up to 5 years from intervention), aneurysm-related mortality (30 days and 12 months), all-cause mortality, spinal cord ischaemia (paraplegia, paraparesis), visceral arterial branch compromise causing mesenteric ischaemia or renal failure, and rate of reintervention.

Data collection and analysis: Two review authors independently screened all titles and abstracts identified from the searches to identify those that met the inclusion criteria. We planned to undertake data collection, risk of bias assessment, and analysis in accordance with Cochrane recommendations. We planned to assess the certainty of the evidence using GRADE.

Main results: No RCTs or CCTs met the inclusion criteria for this review.

Authors' conclusions: Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of endovascular compared to OSR in patients with TAAAs and are unable to provide any evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs addressing this objective are necessary, however conducting such studies will be logistically and ethically challenging for this life-threatening disease.

PubMed Disclaimer

Conflict of interest statement

SS: none known

JC: none known

DV: none known

WT: none known

PMcH: none known

FJ: none known

NH: declares her institution has received payment from Jotec/Cryolife for advanced aortic fellowship training at Liverpool Heart and Chest Hospital

Figures

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Study flow diagram
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012926

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References to other published versions of this review

Concannon 2018
    1. Concannon J, Hynes N, Veerasingam D, Kavanagh EP, McGarry JP, Sultan S, et al. Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No: CD012926. [DOI: 10.1002/14651858.CD012926] - DOI - PMC - PubMed

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