title: Multibranched Stent-Grafts for the Treatment of Thoracoabdominal Aortic Aneurysms: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To evaluate the available literature on endovascular repair of thoracoabdominal (TAAA) and pararenal aortic aneurysms (PRAA) using multibranched stent-grafts.
  
  
  METHODS
  MEDLINE, EMBASE, and Cochrane databases were searched between January 2001 and June 2015 to identify articles related to the use of multibranched stent-grafts for the treatment of TAAA and PRAA. Articles with <4 cases and those on juxtarenal aortic aneurysms were excluded. Meta-analyses were conducted to evaluate 30-day mortality, all-cause mortality, spinal cord ischemia, renal insufficiency, endoleak, target vessel patency, and reintervention. Of 370 articles screened, only 4 articles encompassing 185 patients (mean age 71.1 years; 137 men) were aligned with the inclusion criteria. There were 23 PRAAs; the mean aneurysm diameter was 64.5 mm. The Crawford TAAA classification was 10 type I, 47 type II, 37 type III, 58 type IV, and 9 type V; there was 1 Stanford type B dissection in association with a large TAAA. Results of the meta-analyses are reported as proportions and 95% confidence interval (CI).
  
  
  RESULTS
  Pooled analysis indicated a technical success rate of 98.9%. As study heterogeneity was significant, random effects models were used for meta-analysis. The rate for 30-day mortality was 9% (95% CI 3% to 19%), for all-cause mortality 27% (95% CI 17% to 38%), endoleaks 10% (95% CI 1% to 25%), target vessel patency 98% (95% CI 95% to 99%), SCI 17% (95% CI 1% to 26%), irreversible SCI 6% (95% CI 3% to 10%), renal insufficiency 15% (95% CI 0.8% to 41%), and reinterventions 21% (95% CI 4% to 47%).
  
  
  CONCLUSIONS
  Use of multibranched stent-grafts in the treatment of TAAAs and PRAAs appears to be feasible and safe based on satisfactory early outcomes in the limited literature available to date. Long-term surveillance and further studies are essential to determine the durability of this technique.
authors.affiliation: Medical Center, Tsinghua University, Beijing, China.
authors.forename: Zhongzhou
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: State Key Laboratory of Microbial Technology, School of Life Science, Shandong University, Jinan, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Peng
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiong
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
authors.forename: Hongpeng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China pla301dml@vip.sina.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: endovascular repair; meta-analysis; multibranched stent-graft; pararenal aortic aneurysm; thoracoabdominal aortic aneurysm