SYSTEMATIC REVIEW AND META-ANALYSIS ON ENDOVASCULAR REPAIR OF NON-ELECTIVE THORACO-ABDOMINAL AORTIC ANEURYSMS AND ANEURYSMS INVOLVING VISCERAL ARTERIES.

Introduction: Thoracoabdominal aortic aneurysms (TAAA) and juxta/pararenal abdominal aortic aneurysm reported as complex aortic aneurysms (cAAA), represent a technical and clinical challenge with endovascular repair embodying a preferred option for high risk patients. represent a technical and clinical challenge with endovascular repair embodying a preferred option for high risk patients. However, in case of non-elective presentation, both technical and clinical management and outcomes remain limited in Literature. Aim of this study is to report indications, treatments and outcomes of non-elective endovascular repair of TAAA and cAAA.

Methods: This study is a Systematic review and meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and after PROSPERO registration. Primary endpoints were the indications, technical success and procedure-related mortality. Secondary endpoints were spinal cord ischemia (SCI), grade-3 SCI, dialysis and respiratory events. Meta-regression was performed for non-intact vs intact aneurysm. Subgroups analysis was performed in studies involving exclusively TAAA repair.

Results: Out of 687 articles screened, we selected 18 articles involving 953 patients: TAAA were 68% (51% Crawford I-III, 49% Crawford IV-V) and cAAA were 32%. Indications for non-elective treatment were contained/free rupture, symptoms, large aneurysms diameter. Branched-endograft, physician-modified/in-situ-endograft, parallel graft and fenestrated-endograft were used in 54%, 30%, 14% and 2%, respectively. Technical success was 94.4%. Overall procedural-related mortality was 16.8% (95% Confidence Interval 0.13-0.22; non-intact: 24.5% VS intact:11.8%; p<0.001). Pooled rate for SCI and grade-3 SCI were 12.3% (non-intact:21.9% VS intact:8.9%; p=0.007) and 5.2% (non-intact:8.5% VS intact:2.2%;p=0.02), respectively. Permanent dialysis was 3.6% (non-intact:6.1% VS intact:1.7%; p=0.08) and respiratory events were 14.1 (non-intact:20.7% VS intact:9.3%; p=0.024). Subgroups analysis for TAAA reported procedure-related mortality in 18.7% (non-intact:24.8% VS intact:12.6%; p=0.08); SCI, Grade-3 SCI,dialysis and respiratory events occurred in 16.4%(non-intact:21.9% VS intact:9.7%; p=0.06), 5.6%(non-intact:8.1% VS intact:2.8%; p=0.08), 5.4% (non-intact:7.2% VS intact:2.6%; p=0.36) and 18.2%(non-intact:23.1 VS intact:10.5%; p=0.10), respectively. No statistical differences in meta-regression for non-intact VS intact TAAAs.

Conclusions: The indications for non-elective endovascular treatment of TAAA and cAAA are heterogenous. Technical success is elevated while early mortality and spinal cord injuries were higher for ruptured aneurysm. Interestingly, TAAA outcomes seemed not to be influenced by rupture.