Effectiveness of collateral arteries embolization before endovascular aneurysm repair to prevent type II endoleaks: A systematic review and meta-analysis

Vascular ◽  
2021 ◽  
pp. 170853812110327
Author(s):  
Hanfang Zhang ◽  
Yaoguo Yang ◽  
Lei Kou ◽  
Hong Sun ◽  
Zhong Chen
Keyword(s):  
Controlled Trial ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Control Group ◽  
Type Ii ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Collateral Arteries ◽  
Comprehensive Search ◽  
Aneurysm Repair

Objectives This study aimed to evaluate the effect of preventive collateral arteries embolization before endovascular aneurysm repair (EVAR) to reduce type II endoleaks (T2EL), aneurysm enlargement, and re-interventions. Methods A comprehensive search of PubMed, MEDLINE, Web of Science, and Embase was conducted to identify articles in English, related to preventive collateral arteries embolization before EVAR, published until October 2020. Results A total of 12 relevant studies, including 11 retrospective studies and one randomized controlled trial, were identified and fulfilled the specified inclusion criteria. A total of 1706 patients in 11 studies were involved in the meta-analysis. The overall incidence of T2EL was 17.3% in the embolization group vs. 34.5% in the control group (OR 0.36, p < 0.01). The incidence of persistent T2EL was 15.3% vs. 30.0% (OR 0.37, p < 0.01). Five studies reported the incidence of sac enlargement, with the rate 10.2% vs. 24.9% (OR 0.25, p < 0.01). Nine studies reported T2EL related re-interventions, and it was 1.3% in the embolization group and 10.4% in control (OR 0.14, p < 0.01). The technical success of collateral arteries embolization was 92.1% (455/494) in the 12 studies. 1.2% (10/829) patients suffered a mild complication of collateral arteries embolization, and 2/829 patients died because of the embolization. Conclusion Collateral arteries embolization is a promising measure to prevent the occurrence of T2EL, sac enlargement, and re-intervention. High-quality studies need to be conducted to provide stronger evidence-based medical suggestions about the embolize operation.

scholarly journals Impact of Adjuvant Use of Midodrine to Intravenous Vasopressors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ahmad Al-Abdouh ◽  
Sadam Haddadin ◽  
Atul Matta ◽  
Ahmad Jabri ◽  
Mahmoud Barbarawi ◽  
...  
Keyword(s):  
Retrospective Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
Risk Ratios

Purpose. To evaluate the efficacy and safety of midodrine use in intensive care units (ICU) to facilitate weaning off intravenous vasopressors (IVV). Methods. We searched PubMed/MEDLINE, Cochrane library, and Google Scholar (inception through October 18th, 2020) for studies evaluating adjuvant use of midodrine to IVV in the ICU. The outcomes of interest were ICU length of stay (LOS), hospital LOS, mortality, IVV reinstitution, ICU readmission, and bradycardia. Estimates were pooled using the random-effects model. We reported effect sizes as standardized mean difference (SMD) for continuous outcomes and risk ratios (RRs) for other outcomes with a 95% confidence interval (CI). Results. A total of 6 studies were found that met inclusion criteria and had sufficient data for our quantitative analysis (1 randomized controlled trial and 5 retrospective studies). A total of 2,857 patients were included: 600 in the midodrine group and 2,257 patients in the control group. Midodrine use was not associated with a significant difference in ICU LOS (SMD 0.16 days; 95% CI −0.23 to 0.55), hospital LOS (SMD 0.03 days; 95% CI −0.33 to 0.0.39), mortality (RR 0.87; 95% CI 0.52 to 1.46), IVV reinstitution (RR 0.47; 95% CI 0.17 to 1.3), or ICU readmission (RR 1.03; 95% CI 0.71 to 1.49) when compared to using only IVV. However, there were higher trends of bradycardia with midodrine use that did not reach significance (RR 7.64; 95% CI 0.23 to 256.42). Conclusion. This meta-analysis suggests that midodrine was not associated with a significant decrease in ICU LOS, hospital LOS, mortality, or ICU readmissions.

scholarly journals Multicentre randomised controlled trial to evaluate the efficacy of pre-emptive inferior mesenteric artery embolisation during endovascular aortic aneurysm repair on aneurysm sac change: protocol of Clarify IMA study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e031758 ◽  
Author(s):  
Shigeo Ichihashi ◽  
Mitsuyoshi Takahara ◽  
Naoki Fujimura ◽  
Satoru Nagatomi ◽  
Shinichi Iwakoshi ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Aortic Aneurysm ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Controlled Trial ◽  
Endovascular Aneurysm Repair ◽  
Control Group ◽  
Type Ii ◽  
Randomised Controlled ◽  
Aneurysm Repair

IntroductionType II endoleak (EL) is frequently seen after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) and is often considered responsible for aneurysm sac enlargement if it persists. In order to reduce type II EL and consequent sac enlargement, pre-emptive embolisation of the inferior mesenteric artery (IMA), which is a main source for persistent type II EL, has been introduced in many vascular centres. At present, there is a lack of robust evidence to support the efficacy of pre-emptive embolisation of IMA on reduction of persistent type II EL with subsequent sac shrinkage.Method and analysisThis multicentre, randomised controlled trial will recruit 200 patients who have fusiform AAA ≥50 mm/rapidly enlarging fusiform AAA, with patent IMA, and randomly allocate them either to a pre-emptive IMA embolisation group or non-embolisation control group in a ratio of 1:1. The primary endpoint is the difference of aneurysm sac volume change assessed by CT scans between the pre-emptive IMA embolisation group and the control group at 12 months after EVAR. The secondary endpoints are defined as change of aneurysm sac volume in both groups at 6 and 24 months, freedom from sac enlargement at 12 and 24 months after EVAR, prevalence of type II EL at 1, 6, 12 and 24 months evaluated by contrast-enhanced CT, reintervention rate, aneurysm related mortality, overall survival, perioperative morbidity, volume of contrast media used during EVAR and dosage of radiation.Ethics and disseminationThe protocol has been reviewed and approved by the ethics committee of Nara Medical University (No. 2113). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry home page.Trial registration numberUMIN000035502.

Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease

2017 ◽  
Vol 10 (6) ◽  
pp. 596-601 ◽  
Author(s):  
Panya Luksanapruksa ◽  
Jacob M Buchowski ◽  
Sasima Tongsai ◽  
Weerasak Singhatanadgige ◽  
Jack W Jennings
Keyword(s):  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Spinal Metastases ◽  
Mean Difference ◽  
Control Group ◽  
Preoperative Embolization ◽  
Inclusion Criteria ◽  
Qualitative Synthesis ◽  
Randomized Controlled

BackgroundPreoperative embolization (PE) may decrease intraoperative blood loss (IBL) in decompressive surgery of hypervascular spinal metastases. However, no consensus has been found in other metastases and no meta-analysis which reviewed the benefit of PE in spinal metastases has been conducted.ObjectiveTo assess IBL in spinal metastases surgery in a randomized controlled trial (RCT) and cohort studies comparing PE and a control group of non-embolized patients.MethodsA systematic search of relevant publications in PubMed and EMBASE was undertaken. Inclusion criteria were RCTs and observational studies in patients with spinal metastases who underwent spine surgery and reported IBL. Meta-analysis was performed using standardized mean difference (SMD) and mean difference (MD) of IBL. Heterogeneity was assessed using the I2 statistic.ResultsA total of 265 abstracts (126 from PubMed and 139 from Embase) were identified through database searching. The reviewers selected six studies for qualitative synthesis and meta-analysis. The pooled SMD of the included studies was 0.58 (95% CI −0.10 to 1.25, p=0.09). Sensitivity analysis revealed that, if the study by Rehak et al was omitted, the pooled SMD was significantly changed to 0.88 (95% CI 0.39 to 1.36, p<0.001) and PE reduced the IBL significantly. The pooled MD was 708.3 mL (95% CI −224.4 to 1640.9 mL, p=0.14). If the results of the Rehak et al study were omitted, the pooled MD was significantly changed to 1226.9 mL (95% CI 345.8 to 2108.1 mL, p=0.006).ConclusionsPE can be effective in reducing IBL in spinal metastases surgery in both renal cell carcinoma and mixed primary tumor groups.

Abstract P311: Effect of Non-Invasive Imaging on Cardiovascular Risk Factors and Downstream Testing: A Meta-Analysis of Randomized Controlled Trials

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Seamus P Whelton ◽  
Khurram Nasir ◽  
Michael J Blaha ◽  
Daniel S Berman ◽  
Roger S Blumenthal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Statistical Power ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cardiovascular Imaging ◽  
Significant Trend ◽  
Inclusion Criteria ◽  
Non Invasive ◽  
Randomized Controlled

Introduction: Non-invasive cardiovascular imaging has been proposed as a method to improve risk stratification and motivate improved patient and physician risk factor modification. Despite increasing use of these technologies there remains limited evidence documenting its effect on downstream testing and improvement in risk factor control. Hypothesis: Addition of the EISNER study to a prior meta-analysis will improve statistical power to demonstrate the downstream consequences of non-invasive cardiovascular imaging. Methods: A comprehensive literature search of the MEDLINE database (1966 through July 2011) was conducted. Major inclusion criteria required: 1) randomized controlled trial design, 2) participants with no known history of coronary heart disease or stroke, and 3) comparison of a group provided with results of a non-invasive imaging scan versus those without results. A total of eight trials with 4,084 participants met the inclusion criteria for this analysis. We analyzed the data using a random effects model to allow for heterogeneity. Results: Among imaging groups there was a significant increase in prescribing for statins (RR, 1.15; 95% CI, 1.01–1.32) and a non-significant trend for increased prescription of aspirin (RR, 1.15; 95% CI, 0.97–1.35), ACE/ARB (RR, 1.12; 95% CI, 0.96–1.31), and insulin (RR, 1.54; 95% CI, 0.75–3.18). There was a non-significant trend towards increased smoking cessation (RR, 1.35; 95% CI, 0.88–2.08). For downstream outcomes there was a non-significant increase in coronary angiography (RR, 1.20; 95% CI, 0.92–1.57), but not for revascularization (RR, 0.92; 95% CI, 0.55–1.53). There was no significant effect of imaging on the change in traditional risk factors. Limitations: There remains a limited number of trials in this important area. Therefore, trials included in this analysis use a variety of different imaging modalities and we were not able to pool the results based on appropriate clinical action (intensification at high risk and reduction at low risk). Conclusions: Non-invasive cardiovascular imaging leads to increased statin use, but associations with other downstream treatments and change in risk factors are not statistically significant. Our results highlight the limited amount of data for describing the downstream consequences after CAC testing.

A Randomized Controlled Trial: The Effect of Acupressure and Foot Reflexology on Pain During Heel-Lancing in Neonates

2021 ◽  
pp. 105477382110618
Author(s):  
Ayşe Özge Deniz ◽  
Ayfer Açikgöz
Keyword(s):  
Controlled Trial ◽  
Controlled Study ◽  
Procedural Pain ◽  
Control Group ◽  
Intergroup Difference ◽  
Inclusion Criteria ◽  
Sedation Scale ◽  
Neonatal Pain ◽  
Randomized Controlled ◽  
Pain Scores

This randomized controlled study aimed to determine the effects of acupressure and foot reflexology on procedural pain during heel-lancing in newborns. This study was conducted with 105 neonates (35 foot reflexology group, 35 acupressure group, and 35 control group) who met the inclusion criteria and who were delivered by cesarean section between October 2017 and March 2018 at a state hospital in Turkey. A “Newborn Information Form” and a “Neonatal Pain, Agitation, and Sedation Scale” (N-PASS) were used to collect data. The study found a significant intergroup difference between pain scores of neonates during the procedures ( p < .05). Advanced analyses found that the pain scores in the acupressure and foot reflexology groups were similar, whereas the pain scores in the control group were higher than in the other two groups. Acupressure and foot reflexology administered during heel lancing in newborns are effective methods for reducing pain.

scholarly journals Whether stoma support rods have application value in loop enterostomy: a systematic review and meta-analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Rui Du ◽  
Jiajie Zhou ◽  
Feng Wang ◽  
Dongliang Li ◽  
Guifan Tong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Total Incidence ◽  
The Difference ◽  
Effect Of Support ◽  
Experimental Group

Abstract Purpose The purpose of the systematic review and meta-analysis is to analyze the application value of the stoma support rods in loop enterostomy. Methods The studies on the application of stoma rods in loop enterostomy published from January 2000 to January 2020 were searched in the databases of PubMed, Embase, Cochrane library, and Clinical trials. All randomized controlled trials (RCTs) and cohort studies that observed the value of stoma rods were included according to inclusion criteria. The RevMan5.3 software was used for statistical analysis. Results A total of 1131 patients with loop enterostomy in six studies were included in this study; there were 569 cases in the experimental group and 562 cases in the control group. All six studies analyzed the effect of support rods on the incidence of stoma retraction; the meta-analysis showed that in a total of 32 patients, stoma retraction occurred, with a total incidence of about 2.8% in 1131 patients. The incidence of stoma retraction in the rod group was not significantly lower than that in the non-rod group, and the difference was not statistically significant (OR = 0.65, 95% CI 0.32~1.32, I2 = 0%, P = 0.23), and the studies were homogeneous. The incidences of stoma necrosis (OR = 6.41, 95% CI 2.22~18.55, I2 = 0%, P = 0.0006), peristomal dermatitis (OR = 2.93, 95% CI 2.01~4.27, I2 = 0%, P < 0.00001), and mucocutaneous separation (OR = 2.14, 95% CI 1.03~4.47, I2 = 0%, P = 0.04) were significantly increased in the rod group. Conclusions It is not recommended to routinely use stoma support rods in the clinical practice.

Sac Embolization and Side Branch Embolization for Preventing Type II Endoleaks After Endovascular Aneurysm Repair: A Meta-analysis

2019 ◽  
Vol 27 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Qiyi Li ◽  
Peiyong Hou
Keyword(s):  
Randomized Trials ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Side Branch ◽  
Type I ◽  
Type Ii ◽  
Related Complication ◽  
Type Ii Endoleak ◽  
Random Effects Models ◽  
Aneurysm Repair

Purpose:To investigate the efficacy and safety of preoperative side branch embolization or intraoperative sac embolization for preventing type II endoleaks after endovascular aneurysm repair (EVAR). Materials and Methods: A systematic literature search of MEDLINE and EMBASE was performed to identify studies that evaluated the outcomes of sac embolization vs no embolization or side branch embolization vs no embolization in patients who received EVAR. Among the 904 studies screened, 17 studies with 2084 participants were included in this review. Outcome measures included the type II endoleak rate, the reintervention rate for type II endoleaks, the incidence of types I/III endoleaks, and the rate of complications. Fixed (no heterogeneity) or random effects models were constructed for each outcome; the results are presented as the odds ratio (OR) with 95% confidence interval (CI). Results: The sac embolization group had significantly lower type II endoleak (OR 0.21, 95% CI 0.13 to 0.34, p<0.001) and reintervention (OR 0.15, 95% CI 0.07 to 0.33, p<0.001) rates than the no embolization group. No significant differences between the 2 groups were found for the type I/III endoleak rate (OR 0.57, 95% CI 0.23 to 1.37, p=0.21) or complication rate (OR 1.22, 95% CI 0.32 to 4.70, p=0.77). Compared with no embolization, side branch embolization was also associated with a decrease in type II endoleak (OR 0.35, 95% CI 0.21 to 0.60, p<0.001) and reinterventions (OR 0.10, 95% CI 0.04 to 0.27, p<0.001). One severe procedure-related complication (fatal colon ischemia) was reported in the side branch embolization group. Conclusion: Sac embolization and side branch embolization are safe and effective in preventing type II endoleaks. Further randomized trials are needed to directly compare the clinical outcomes of these procedures.

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