Effectiveness and safety of fenestrated endograft <i>versus</i> chimney stent repair for juxtarenal abdominal aortic aneurysms: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Lei , HUANG Shengnan , LI Xinxi , TIAN Ye , BAI Chao , Yidiresi· Aishan ,  LUO Jun

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding author：

LUO Jun, Email: xmuluo@163.com

Keywords：

juxtarenal abdominal aortic aneurysm; fenestrated endovascular aneurysm repair; chimney endovascular aneurysm repair; effectiveness; safety

DOI：

10.7507/1007-9424.202001048

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Objective To systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).Methods The databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.Results A total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).Conclusions Both F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.

Citation： ZHANG Lei, HUANG Shengnan, LI Xinxi, TIAN Ye, BAI Chao, Yidiresi· Aishan, LUO Jun. Effectiveness and safety of fenestrated endograft versus chimney stent repair for juxtarenal abdominal aortic aneurysms: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1277-1283. doi: 10.7507/1007-9424.202001048 Copy

1.	Parodi JC. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms//Jamieson CW, Yao JT. Vascular surgery. New York: Springer, 1994.
2.	陈忠, 王盛, 唐小斌, 等. 腹主动脉瘤开放手术与腔内修复术中期结果比较的单中心前瞻性研究. 中华外科杂志, 2011, 49(10): 869-872.
3.	Bisdas T, Weiss K, Eisenack M, <italic>et al</italic>. Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2014, 60(5): 1125-1131.
4.	Leotta DF, Starnes BW. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms. J Vasc Surg, 2015, 61(6): 1637-1641.
5.	Bi Y, Han X, Xu K, <italic>et al</italic>. Re: “Endovascular aneurysm sealing for infrarenal abdominal aortic aneurysms: 30 day outcomes of 105 patients in a single centre”. Eur J Vasc Endovasc Surg, 2015, 50(4): 542.
6.	Wells G, Shea B, O’connell D, <italic>et al</italic>. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa, 2014.
7.	Donas KP, Eisenack M, Panuccio G, <italic>et al</italic>. The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms. J Vasc Surg, 2012, 56(2): 285-290.
8.	Lee JT, Lee GK, Chandra V, <italic>et al</italic>. Comparison of fenestrated endografts and the snorkel/chimney technique. J Vasc Surg, 2014, 60(4): 849-856.
9.	Suominen V, Pimenoff G, Salenius J. Fenestrated and chimney endografts for juxtarenal aneurysms: early and midterm results. Scand J Surg, 2013, 102(3): 182-188.
10.	Banno H, Cochennec F, Marzelle J, <italic>et al</italic>. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg, 2014, 60(1): 31-39 .
11.	Ronchey S, Serrao E, Kasemi H, <italic>et al</italic>. Endovascular treatment options for complex abdominal aortic aneurysms. J Vasc Interv Radiol, 2015, 26(6): 842-854.
12.	Ullery BW, Suh GY, Lee JT, <italic>et al</italic>. Comparative geometric analysis of renal artery anatomy before and after fenestrated or snorkel/chimney endovascular aneurysm repair. J Vasc Surg, 2016, 63(4): 922-929.
13.	Caradu C, Morin J, Poirier M, <italic>et al</italic>. Monocentric evaluation of chimney <italic>versus</italic> fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm. Ann Vasc Surg, 2017, 40: 28-38.
14.	Chinsakchai K, Prapassaro T, Salisatkorn W, <italic>et al</italic>. Outcomes of open repair, fenestrated stent grafting, and chimney grafting in juxtarenal abdominal aortic aneurysm: is it time for a randomized trial? Ann Vasc Surg, 2019, 56: 114-123.
15.	Bannazadeh M, Beckerman WE, Korayem AH, <italic>et al</italic>. Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution. J Vasc Surg, 2020, 71(1): 15-22.
16.	Park JH, Chung JW, Choo IW, <italic>et al</italic>. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol, 1996, 7(6): 819-823.
17.	Ouriel K, Greenberg RK, Clair DG, <italic>et al</italic>. Endovascular aneurysm repair: gender-specific results. J Vasc Surg, 2003, 38(1): 93-98.
18.	马晓辉, 郭伟, 刘小平, 等. “烟囱”技术腔内修复近肾腹主动脉瘤对肾功能的影响. 中华普通外科杂志, 2016, 31(8): 620-623.
19.	Dijkstra ML, Tielliu IF, Meerwaldt R, <italic>et al</italic>. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg, 2014, 60(2): 301-307.
20.	Ketelsen D, Thomas C, Schmehl J, <italic>et al</italic>. Endovascular aneurysm repair of abdominal aortic aneurysms: standards, technical options and advanced indications. Rofo, 2014, 186(4): 337-347.
21.	Yang YG, Zhong C, Lei K, <italic>et al</italic>. Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis. Vascular, 2017, 25(1): 92-100.
22.	Caradu C, Berard X, Sassoust G, <italic>et al</italic>. Chimney versus fenestrated endovascular aortic repair for juxta-renal aneurysms. J Cardiovasc Surg (Torino), 2018, 59(4): 600-610.
23.	Georgiadis GS, van Herwaarden JA, Saengprakai W, <italic>et al</italic>. Endovascular treatment of complex abdominal and thoracoabdominal type Ⅳ aortic aneurysms with fenestrated technology. J Cardiovasc Surg (Torino), 2017, 58(4): 574-590.
24.	Roos H, Djerf H, Brisby Jeppsson L, <italic>et al</italic>. Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study. BMC Cardiovasc Disord, 2016, 16: 124.
25.	黄建华, 刘睿. 短瘤颈腹主动脉瘤的腔内修复策略. 中国普通外科杂志, 2018, 27(6): 679-683.
26.	Scali ST, Kim M, Kubilis P, <italic>et al</italic>. Implementation of a bundled protocol significantly reduces risk of spinal cord ischemia after branched or fenestrated endovascular aortic repair. J Vasc Surg, 2018, 67(2): 409-423.
27.	Perini P, de Troia A, Tecchio T, <italic>et al</italic>. Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair. J Vasc Surg, 2017, 66(4): 1048-1055.
28.	袁丁, 赵纪春, 王家嵘, 等. 2018年美国血管外科学会(ASVS)腹主动脉瘤诊治临床实践指南解读. 中国循证医学杂志, 2018, 18(12): 13-20.

1. Parodi JC. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms//Jamieson CW, Yao JT. Vascular surgery. New York: Springer, 1994.
2. 陈忠, 王盛, 唐小斌, 等. 腹主动脉瘤开放手术与腔内修复术中期结果比较的单中心前瞻性研究. 中华外科杂志, 2011, 49(10): 869-872.
3. Bisdas T, Weiss K, Eisenack M, <italic>et al</italic>. Durability of the Endurant stent graft in patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2014, 60(5): 1125-1131.
4. Leotta DF, Starnes BW. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms. J Vasc Surg, 2015, 61(6): 1637-1641.
5. Bi Y, Han X, Xu K, <italic>et al</italic>. Re: “Endovascular aneurysm sealing for infrarenal abdominal aortic aneurysms: 30 day outcomes of 105 patients in a single centre”. Eur J Vasc Endovasc Surg, 2015, 50(4): 542.
6. Wells G, Shea B, O’connell D, <italic>et al</italic>. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa, 2014.
7. Donas KP, Eisenack M, Panuccio G, <italic>et al</italic>. The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms. J Vasc Surg, 2012, 56(2): 285-290.
8. Lee JT, Lee GK, Chandra V, <italic>et al</italic>. Comparison of fenestrated endografts and the snorkel/chimney technique. J Vasc Surg, 2014, 60(4): 849-856.
9. Suominen V, Pimenoff G, Salenius J. Fenestrated and chimney endografts for juxtarenal aneurysms: early and midterm results. Scand J Surg, 2013, 102(3): 182-188.
10. Banno H, Cochennec F, Marzelle J, <italic>et al</italic>. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg, 2014, 60(1): 31-39 .
11. Ronchey S, Serrao E, Kasemi H, <italic>et al</italic>. Endovascular treatment options for complex abdominal aortic aneurysms. J Vasc Interv Radiol, 2015, 26(6): 842-854.
12. Ullery BW, Suh GY, Lee JT, <italic>et al</italic>. Comparative geometric analysis of renal artery anatomy before and after fenestrated or snorkel/chimney endovascular aneurysm repair. J Vasc Surg, 2016, 63(4): 922-929.
13. Caradu C, Morin J, Poirier M, <italic>et al</italic>. Monocentric evaluation of chimney <italic>versus</italic> fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm. Ann Vasc Surg, 2017, 40: 28-38.
14. Chinsakchai K, Prapassaro T, Salisatkorn W, <italic>et al</italic>. Outcomes of open repair, fenestrated stent grafting, and chimney grafting in juxtarenal abdominal aortic aneurysm: is it time for a randomized trial? Ann Vasc Surg, 2019, 56: 114-123.
15. Bannazadeh M, Beckerman WE, Korayem AH, <italic>et al</italic>. Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution. J Vasc Surg, 2020, 71(1): 15-22.
16. Park JH, Chung JW, Choo IW, <italic>et al</italic>. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol, 1996, 7(6): 819-823.
17. Ouriel K, Greenberg RK, Clair DG, <italic>et al</italic>. Endovascular aneurysm repair: gender-specific results. J Vasc Surg, 2003, 38(1): 93-98.
18. 马晓辉, 郭伟, 刘小平, 等. “烟囱”技术腔内修复近肾腹主动脉瘤对肾功能的影响. 中华普通外科杂志, 2016, 31(8): 620-623.
19. Dijkstra ML, Tielliu IF, Meerwaldt R, <italic>et al</italic>. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg, 2014, 60(2): 301-307.
20. Ketelsen D, Thomas C, Schmehl J, <italic>et al</italic>. Endovascular aneurysm repair of abdominal aortic aneurysms: standards, technical options and advanced indications. Rofo, 2014, 186(4): 337-347.
21. Yang YG, Zhong C, Lei K, <italic>et al</italic>. Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis. Vascular, 2017, 25(1): 92-100.
22. Caradu C, Berard X, Sassoust G, <italic>et al</italic>. Chimney versus fenestrated endovascular aortic repair for juxta-renal aneurysms. J Cardiovasc Surg (Torino), 2018, 59(4): 600-610.
23. Georgiadis GS, van Herwaarden JA, Saengprakai W, <italic>et al</italic>. Endovascular treatment of complex abdominal and thoracoabdominal type Ⅳ aortic aneurysms with fenestrated technology. J Cardiovasc Surg (Torino), 2017, 58(4): 574-590.
24. Roos H, Djerf H, Brisby Jeppsson L, <italic>et al</italic>. Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study. BMC Cardiovasc Disord, 2016, 16: 124.
25. 黄建华, 刘睿. 短瘤颈腹主动脉瘤的腔内修复策略. 中国普通外科杂志, 2018, 27(6): 679-683.
26. Scali ST, Kim M, Kubilis P, <italic>et al</italic>. Implementation of a bundled protocol significantly reduces risk of spinal cord ischemia after branched or fenestrated endovascular aortic repair. J Vasc Surg, 2018, 67(2): 409-423.
27. Perini P, de Troia A, Tecchio T, <italic>et al</italic>. Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair. J Vasc Surg, 2017, 66(4): 1048-1055.
28. 袁丁, 赵纪春, 王家嵘, 等. 2018年美国血管外科学会(ASVS)腹主动脉瘤诊治临床实践指南解读. 中国循证医学杂志, 2018, 18(12): 13-20.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness and safety of fenestrated endograft versus chimney stent repair for juxtarenal abdominal aortic aneurysms: a meta-analysis

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