Systematic review and meta-analysis on the outcomes after fenestrated-branched endovascular repair in postdissection thoracoabdominal aortic aneurysms.
meta_analysis · Level I
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- Record sourced from PubMed, PMID 42320804.
- Also identified by DOI 10.1016/j.jvs.2026.05.053.
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Abstract
Endovascular aortic repair using fenestrated and branched endografts [fenestrated endovascular aortic repair (FEVAR) and branched endovascular aortic repair (BEVAR)] has emerged as an alternative to open surgery for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). However, outcomes remain heterogeneous and target vessel (TV) durability represents a major concern. This systematic review and meta-analysis aimed to evaluate clinical outcomes and TV-related events following FEVAR and BEVAR for PD-TAAAs. A systematic search of MEDLINE, Embase, and the Cochrane Library was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting outcomes of fenestrated and/or branched endovascular repair for PD-TAAAs were included. Outcomes were defined and scored according to the Society for Vascular Surgery reporting standards. The primary outcome was TV instability. Secondary outcomes included TV-related reintervention, major adverse events (MAE), and early and late mortality. Pooled event rates were calculated using random-effects meta-analysis. Seventeen retrospective studies including 912 patients and 3229 TV were analyzed. Technical success was achieved in 96.0% of cases. In the overall analysis, pooled major adverse events and early mortality rate were 4.6% (I<sup>2</sup> = 80%) and 4.1% (I<sup>2</sup> = 0%), respectively. After a mean follow-up of 23.5 months, pooled mortality was 12.8% (I<sup>2</sup> = 43%); TV instability and TV reintervention were 7.6% (I<sup>2</sup> = 58%) and 6.9% (I<sup>2</sup> = 35%), respectively. When reported, renal arteries showed higher rates of TV instability (4.0%, I<sup>2</sup> = 32%) and TV-related reintervention (4.1%, I<sup>2</sup> = 48%) compared with visceral arteries (3.1%; I<sup>2</sup> = 55% and 2.9%, I<sup>2</sup> = 56%, respectively). Owing to the high degree of heterogeneity in outcome reporting, a direct comparison between FEVAR and BEVAR was not feasible. Complex endovascular repair represents a viable strategy for PD-TAAAs, with high technical success and satisfactory midterm outcomes. TV durability, particularly at the renal level, remains the main limitation, highlighting the need for standardized reporting and prospective studies with longer follow-up.