4.5 Review

Meta-Analysis of Compliance with Endovascular Aneurysm Repair Surveillance: The EVAR Surveillance Paradox

期刊

出版社

W B SAUNDERS CO LTD
DOI: 10.1016/j.ejvs.2022.10.033

关键词

Abdominal aortic aneurysm; Endovascular aneurysm repair; EVAR; Follow up; Surveillance

向作者/读者索取更多资源

The objective of this study is to compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant. Thirteen cohort studies with a total of 22,762 patients were included. The results showed no statistically significant difference in the hazard of all cause mortality, aneurysm related mortality, or secondary intervention between patients who had incomplete and complete follow up after EVAR. The certainty of evidence was very low for all outcomes. The conclusion is that patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant, questioning the value of intense surveillance in all patients post-EVAR and highlighting the need for further research on individualized or risk adjusted surveillance.
Objective: To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant. Data sources: MEDLINE and Embase were searched using the Ovid interface. Review methods: A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients with non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow up. The risk of bias was assessed with the Newcastle -Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm related death. Effect measures were the hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random effects models. Results: Thirteen cohort studies with a total of 22 762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36 -51). No statistically significant difference was found in the hazard of all cause mortality (HR 1.04, 95% CI 0.61 -1.77), aneurysm related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31 -1.41) between patients who had incomplete and complete follow up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39 -1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance vs. those with complete surveillance showed no significant difference in all cause mortality (HR 1.10, 95% CI 0.43 -2.80). Conclusion: Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. These findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualised or risk adjusted surveillance.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.5
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据