REVIEW  LATEST UPDATE AND EVIDENCE OF OFF-THE-SHELF TREATMENT OPTIONS FOR COMPLEX AAAS 

The Journal of Cardiovascular Surgery 2024 April;65(2):124-31

DOI: 10.23736/S0021-9509.24.12995-3

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Physician-modified versus chimney endografting for pararenal aortic aneurysms: a systematic review and meta-analysis

Georgios I. KARAOLANIS ^{1, 2} ✉, Dimitrios D. PAPAZOGLOU ¹, Konstantinos P. DONAS ^{1, 3}, Fabrice HELFENSTEIN ⁴, Drosos KOTELIS ¹, Vladimir MAKALOSKI ¹

¹ Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ² Vascular Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, Ioannina, Greece; ³ Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinics Langen, Wiesbaden, Seligenstadt, Germany; ⁴ Clinical Trials Unit, University of Bern, Bern, Switzerland

INTRODUCTION: We performed a systematic review and meta-analysis to assess the existing published evidence regarding the safety and efficacy of the endovascular aortic repair with chimney technique (ch-EVAR) and physician-modified stent-grafts (PMSGs) for the treatment of pararenal aortic aneurysm repair.
EVIDENCE ACQUISITION: A systematic search of all relevant studies reported until October 2023 according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. The pooled 30-day mortality, peri- and postoperative complication rates were estimated using fixed or random effect methods.
EVIDENCE SYNTHESIS: A total of 679 study titles were identified by the initial search strategy, of which 16 were considered eligible for inclusion in the meta-analysis. A total of 1094 patients (ch-EVAR N.=861 and PMSG N.=233) (90% male) were identified. The pooled 30-day mortality rate was 3.4% for ch-EVAR and 2.6% for PMSG. The major adverse events (MAE) in the early period was 14.7% for ch-EVAR and 18.5% PMSG, respectively. Higher occlusion rate was observed of the chimney stents grafts (8.2%) than the bridging stents (1.4%) during the follow-up period.
CONCLUSIONS: Ch-EVAR and physician-modified technology are safe with low 30-day mortality in elective settings for pararenal aortic aneurysms repair. No significant differences were seen between the two surgical methods regarding the early major adverse events rate. However, higher occlusion rate for the chimneys can be expected over time.

KEY WORDS: Aortic aneurysm; Blood vessel prosthesis; Stents