Patricia Barrionuevo1, Mahmoud B Malas2, Besma Nejim3, Abdullah Haddad4, Allison Morrow1, Oscar Ponce1, Bashar Hasan1, Mohamed Seisa1, Rabih Chaer5, M Hassan Murad6. 1. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn. 2. Division of Vascular and Endovascular Surgery, The University of California, San Diego Health System, San Diego, Calif. 3. Department of Vascular Surgery, Penn State Health, Milton S. Hershey Medical Center, Philadelphia, Pa. 4. Section of Cardiology, Temple University-Lewis Katz School of Medicine, Philadelphia, Pa. 5. University of Pittsburgh Medical Center, Pittsburgh, Pa. 6. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
Abstract
BACKGROUND: The evidence supporting management decisions of visceral artery aneurysms (VAAs) is sparse. Practice guidelines are needed to help patients and surgeons choose between endovascular and open surgery approaches. METHODS: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with VAAs. Studies were selected and appraised by pairs of independent reviewers. Meta-analysis was performed when appropriate. RESULTS: We included 80 observational studies that were mostly noncomparative. Data were available for 2845 aneurysms, comprising 1279 renal artery, 775 splenic artery, 359 hepatic artery, 226 pancreaticoduodenal and gastroduodenal arteries, 95 superior mesenteric artery, 87 celiac artery, 15 jejunal, ileal and colic arteries, and 9 gastric and gastroepiploic arteries. Differences in mortality between open and endovascular approaches were not statistically significant. The endovascular approach was used more often by surgeons. The endovascular approach was associated with shorter hospital stay and lower rates of cardiovascular complications but higher rates of reintervention. Postembolization syndrome rates ranged from 9% (renal) to 38% (splenic). Coil migration ranged from 8% (splenic) to 29% (renal). Otherwise, access site complication were low (<5%). Pseudoaneurysms tended to have higher mortality and reintervention rates. CONCLUSIONS: This systematic review provides event rates for outcomes important to patients with VAAs. Despite the low certainty warranted by the evidence, these rates along, with surgical expertise and anatomic feasibility, can help patients and surgeons in shared-decision making.
BACKGROUND: The evidence supporting management decisions of visceral artery aneurysms (VAAs) is sparse. Practice guidelines are needed to help patients and surgeons choose between endovascular and open surgery approaches. METHODS: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with VAAs. Studies were selected and appraised by pairs of independent reviewers. Meta-analysis was performed when appropriate. RESULTS: We included 80 observational studies that were mostly noncomparative. Data were available for 2845 aneurysms, comprising 1279 renal artery, 775 splenic artery, 359 hepatic artery, 226 pancreaticoduodenal and gastroduodenal arteries, 95 superior mesenteric artery, 87 celiac artery, 15 jejunal, ileal and colic arteries, and 9 gastric and gastroepiploic arteries. Differences in mortality between open and endovascular approaches were not statistically significant. The endovascular approach was used more often by surgeons. The endovascular approach was associated with shorter hospital stay and lower rates of cardiovascular complications but higher rates of reintervention. Postembolization syndrome rates ranged from 9% (renal) to 38% (splenic). Coil migration ranged from 8% (splenic) to 29% (renal). Otherwise, access site complication were low (<5%). Pseudoaneurysms tended to have higher mortality and reintervention rates. CONCLUSIONS: This systematic review provides event rates for outcomes important to patients with VAAs. Despite the low certainty warranted by the evidence, these rates along, with surgical expertise and anatomic feasibility, can help patients and surgeons in shared-decision making.
Authors: Laura Alonso-Lamberti Rizo; Carlos Bustamante Recuenco; Julián Cuesta Pérez; José Luis Ramos Rodríguez; Andrea Salazar Carrasco; Ainhoa Valle Rubio; Virginia Jiménez Carneros; Francisco Javier Jiménez Miramón; José María Jover Navalón Journal: Int J Surg Case Rep Date: 2020-08-29