Early results and outcome predictors of the off-the-shelf t-branch endograft for endovascular repair of thoracoabdominal aortic aneurysms: a systematic review and meta-analysis

Abstract

ObjectiveTo determine the outcomes of endovascular thoracoabdominal aortic aneurysm (TAAA) repair using t-branch stent graft.MethodsWe performed a systematic search for relevant studies published after 2012 in MEDLINE, Embase, Web of Science, and Cochrane CENTRAL registry. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (protocol CRD42022378654). Validity and risk of bias were assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool. Both random- and fixed-effects models were used to calculate the pooled effect sizes, where appropriate. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity.ResultsEleven reports from 10 retrospective observational studies, comprising 997 patients, were included. Regarding the perioperative outcomes, the overall technical success rate was 94.2 (95 confidence interval (CI) 90.1-96.6), 30-day mortality 9.0 (95 CI 5.0-13.4), spinal cord ischemia (SCI) 6.7 (95 CI 5.4-8.2), early endoleak 3.5 (95 CI 2.7-4.5), acute kidney injury (AKI) 13.8 (95 CI 8.7-21.3), permanent dialysis 2.5 (95 CI 1.2-5.4), and early reintervention 110 per 1000 person-years (95 CI 68-174). Negative regression coefficients were observed between the number of elective cases and 30-day mortality, AKI, and permanent dialysis. There was a positive regression coefficient between permanent dialysis and American Society of Anesthesiologists (ASA) class 4-5, the number of ruptured aneurysms, and Crawford class I-II-III. The overall mortality beyond the first 30 days was 138 per 1000 person-years.ConclusionT-branch stent graft is a safe and effective option to use in endovascular TAAA repair with a good technical success rate and acceptable rate of mortality and complications.