The use of different commercial types of iliac branch devices for the preservation of hypogastric artery during endovascular aortic repair: A systematic review and meta-analysis

Common iliac aneurysms are present in up to 40% of abdominal aortic aneurysms and these create a challenging aspect in endovascular aneurysm repair. The long-established technique of embolization of the internal iliac artery during endovascular aneurysm repair is associated with pelvic ischemic complications such as buttock claudication, erectile dysfunction, colon ischemia and pelvic necrosis. Iliac branch devices (IBDs), which permit the preservation of hypogastric artery, can prevent these complications. We have conducted a meta-analysis in order to assess the safety and outcomes of the iliac branch devices and explore potential differences among the commercially available types of IBDs.Ανεύρυσμα της κοινής λαγόνιας αρτηρίας εμφανίζεται σε ποσοστό έως και 40% των ανευρυσμάτων κοιλιακής αορτής και καθιστά τεχνικά δύσκολη την ενδαγγειακή αποκατάσταση των ανευρυσμάτων. Η καθιερωμένη τεχνική του εμβολισμού της έσω λαγόνιου αρτηρίας κατά τη διάρκεια την ενδαγγειακής αποκατάστασης των ανευρυσμάτων σχετίζεται με ισχαιμία πυέλου και επιπλοκές όπως διαλείπουσα χωλότητα των γλουτών, στυτική δυσλειτουργία, ισχαιμία του εντέρου και νέκρωση της πυέλου. Ενδοπροθέσεις με λαγόνιο κλάδο, που επιτρέπουν τη διατήρηση της έσω λαγονίου αρτηρίας, μπορούν να αποτρέψουν αυτές τις επιπλοκές. Διενεργήσαμε μια μετα-ανάλυση με σκοπό να αξιολογήσουμε την ασφάλεια και την αποτελεσματικότητα των ενδοπροθέσεων με λαγόνιο κλάδο καθώς και να διερευνήσουμε πιθανές διαφορές των υπάρχοντών εμπορικών διαθέσιμων ενδοπροθέσεων

Management of internal carotid artery near-occlusion: the need for updated evidence

Near occlusion of internal carotid artery (ICA) is a rare and easily misdiagnosed condition and the decision for revascularisation still remains controversial. We conducted an updated meta-analysis in order to investigate outcomes after carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment (BMT) in patients with near-occlusion of the ICA. We also aimed to investigate the role of time as a potential moderator of the near-ICA occlusion-stroke rate association. A multiple electronic health database search on articles published up to November 2019 was performed. The pooled stroke rate after CEA, CAS and BMT were calculated. We also investigated transient ischemic attack (TIA), stroke-related death, myocardial infarction (MI), any cause of death and ICA restenosis crude rates (%). A total of 33 articles were finally deemed eligible. The pooled stroke rate was 1.52% [95% confidence interval (CI): 0.09-4.02%] after CEA, 1.80% (95% CI: 0.61-3.40%) after CAS and 8.39% (95% CI: 3.39-14.80%) after BMT. Out of 896 CEA patients, we recorded 22 TIAs (2.5%), 33 all-cause deaths (3.7%), 5 stroke-related deaths (0.6%) and 6 MIs (0.7%). Concerning outcomes after 603 CAS patients, we recorded 7 TIAs (1.2%), 56 all-cause deaths (9.3%), 4 stroke-related deaths (0.7%) and 22 MIs (3.6%). Among 263 patients who were treated with BMT, we found 16 TIAs (6.1%), 10 all-cause deaths (3.8%), no stroke-related death, and no MI. Crude restenosis rate during follow-up was 9.0% (54/601) for CEA and 4.1% (24/592) for CAS patients. No significant effect of publication year upon stroke rate after CEA was recorded. However, there was a significant reversed association between pooled stroke rate after CAS and publication year (P=0.05). A statistically significant reversed association between pooled stroke rate after BMT and publication year was also recorded (P<0.01). The results of this updated meta-analysis revealed high stroke rate for patients with near-occlusion of ICA who treated only with BMT, while intervention seemed to be safe and effective. A downward trend in the stroke rates over time after CAS and BMT was also discovered. These highlight that patients with near-occlusion of ICA should be included and investigated in future studies

A systematic review and meta-analysis for the management of Paget-Schroetter syndrome

Objective: There is currently no general agreement on the optimal treatment of Paget-Schroetter syndrome. Most centers have advocated an interventional approach that is based on the results of small institutional series. The purpose of our meta-analysis was to focus on the safety and efficacy of thrombolysis or anticoagulation with decompression therapy. A detailed description of the epidemiologic, etiologic, and clinical characteristics, along with radiologic findings and treatment option details, was also performed. Methods: The current meta-analysis was conducted using the PRISMA guidelines. Studies reporting on spontaneous thrombosis or thrombosis after strenuous activities of axillary-subclavian vein were considered eligible. Analyses of all retrospective studies were conducted, and pooled proportions with 95% confidence intervals of outcome rates were calculated. Results: Twenty-five studies with 1511 patients were identified. Among these patients, 1177 (77.9%) had thrombolysis, 658 (43.5%) had anticoagulation, and 1293 (85.6%) patients had decompression therapy of the thoracic outlet. Complete thrombus resolution was estimated at 78.11% of the patients after thrombolysis, and the respective pooled proportion for partial resolution of thrombus was 23.72%. Despite thrombolytic therapy, 212 patients underwent additional balloon angioplasty for residual stenosis, although only 36 stents were implanted. After anticoagulation, a total of 40.70% of the patients had complete thrombus resolution, whereas partial resolution was occurred in 29.13% of the patients. During follow-up, a total of 51.75% of the patients with any initial treatment modality had no remaining thrombus, and 84.87% of these patients were free of symptoms. We also estimated that 76.88% of the patients had a Disabilities of the Arm, Shoulder and Hand score of &lt;20, indicating no or mild symptoms after treatment. A subgroup meta-analysis with 20 studies and 1309 patients, showed significantly improved vein patency and symptom resolution in patients who had first rib resection with or without venoplasty, compared with those who had only thrombolysis. Conclusions: Although no randomized controlled data are available, our analysis strongly suggested higher rates of thrombus and symptoms resolution with thrombolysis, followed by first rib resection. A prospective randomized trial comparing anticoagulants with thrombolysis and decompression of thoracic outlet is required