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A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance

机译：evar后重复预测因子的系统综述：风险分层监测的指导

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Background: Current surveillance protocols after endovascular aneurysm repair (EVAR) are ineffective and costly. Stratifying surveillance by individual risk of reintervention requires an understanding of the factors involved in developing post-EVAR complications. This systematic review assessed risk factors for reintervention after EVAR and proposals for stratified surveillance. Methods: A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting on risk factors predicting reintervention after EVAR and proposals for stratified surveillance. Results: Twenty-nine studies reporting on 39 898 patients met the primary inclusion criteria for reporting predictors of reintervention or aortic complications with or without suggestions for stratified surveillance. Five secondary studies described external validation of risk scores for reintervention or aortic complications. There was great heterogeneity in reporting risk factors identified at the pre-EVAR, intraoperative, and post-EVAR stages of treatment, although large preoperative abdominal aortic aneurysm diameter was the most commonly observed risk factor for reintervention after EVAR. Conclusion: Existing data on predictors of post-EVAR complications are generally of poor quality and largely derived from retrospective studies. Few studies describing suggestions for stratified surveillance have been subjected to external validation. There is a need to refine risk prediction for EVAR failure and to conduct prospective comparative studies of personalized surveillance with standard practice.
机译：背景：血管内动脉瘤修复后的电流监测方案（EVAR）无效且昂贵。个人重新营养风险的分层监测需要了解涉及evar并发症后的因素。这种系统评价评估了EVAR和分层监测建议后重新实施的风险因素。方法：使用Embase和Medline数据库进行系统检索，根据优选的报告项目进行系统评论和Meta-Analys（PRISMA）指南，以确定研究报告报告evar后预测重新监测后重新监测的危险因素。结果：39例患者的二十九项研究报告达到了报告重新入住或主动脉复杂化的预测因子的主要纳入标准，或没有分解监测的建议。五次二级研究描述了对重新入住或主动脉复杂症的风险评分的外部验证。在evar先前，术中和evar后疗法中鉴定的报告危险因素存在很大的异质性，尽管大的术前腹主动脉动脉瘤直径是evar后重复的最常见的危险因素。结论：eVAR后复杂性预测因子的现有数据通常具有差的质量和主要来自回顾性研究。描述了描述分层监测建议的研究已经受到外部验证。有必要改进evar失败的风险预测，并通过标准实践进行个性化监测的前瞻性比较研究。

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