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Cochrane Database of Systematic Reviews

Abordaje de la arteria femoral totalmente percutáneo versus disección quirúrgica para la reparación endovascular programada del aneurisma abdominal bifurcado

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ver la versión actual 11 enero 2023

Información

DOI:
https://doi.org/10.1002/14651858.CD010185.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 21 febrero 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Vascular

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Madelaine Gimzewska

    Cochrane Vascular, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK

  • Alexander IR Jackson

    Correspondencia a: University Hospital Southampton NHS Foundation Trust, Southampton, UK

    [email protected]

    [email protected]

    Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, UK

  • Su Ern Yeoh

    College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK

  • Mike Clarke

    Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK

Contributions of authors

MG: was responsible for trial selection, data extraction, data analysis, and writing the review update
AJ: was responsible for drafting the protocol, trial selection, data extraction, and data analysis in the previous review, and for trial selection and data extraction in this review
SEY: was responsible for trial selection and data extraction in the previous review
MC: was responsible for reviewing the draft protocol and draft review

Sources of support

Internal sources

  • University of Southampton National Institute of Health Research Academic Foundation Programme, UK.

    AIRJ was supported by the University of Southampton National Institute of Health Research Academic Foundation Programme.

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.

    The Cochrane Vascular editorial base is supported by the Chief Scientist Office.

  • National Insitute for Health Research (NIHR), UK.

    This project was supported by the NIHR, via Cochrane Programme Grant funding to Cochrane Vascular (13/89/23). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Declarations of interest

MG: none known
AJ: has declared that he received travel and accommodation expenses for attendance of the Technologies in Endovascular Aortic Repair conference, December 2015. Funding was directly from the conference organisers and enabled an oral presentation of a previous iteration of this review. No other declarations of interest are known
SEY: none known
MC: none known

Acknowledgements

The authors would like to thank all the staff at Cochrane Vascular for all their help, support and patience throughout this review process.

Version history

Published

Title

Stage

Authors

Version

2023 Jan 11

Totally percutaneous versus surgical cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Review

Qi Wang, Jing Wu, Yanfang Ma, Ying Zhu, Xiaoyang Song, Shitong Xie, Fuxiang Liang, Madelaine Gimzewska, Meixuan Li, Liang Yao

https://doi.org/10.1002/14651858.CD010185.pub4

2017 Feb 21

Totally percutaneous versus surgical cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Review

Madelaine Gimzewska, Alexander IR Jackson, Su Ern Yeoh, Mike Clarke

https://doi.org/10.1002/14651858.CD010185.pub3

2014 Feb 27

Totally percutaneous versus standard femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Review

Alexander Jackson, Su Ern Yeoh, Mike Clarke

https://doi.org/10.1002/14651858.CD010185.pub2

2012 Nov 14

Totally percutaneous versus standard femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Protocol

Alexander Jackson, Su Ern Yeoh, Mike Clarke

https://doi.org/10.1002/14651858.CD010185

Differences between protocol and review

The outcome 'Bleeding complications and haematoma' was added to the original review.
The outcome 'Duration of hospital stay' was added to this version of the review.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 1 Short‐term mortality rate (30‐day or in‐hospital).
Figuras y tablas -
Analysis 1.1

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 1 Short‐term mortality rate (30‐day or in‐hospital).

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 2 Aneurysm exclusion.
Figuras y tablas -
Analysis 1.2

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 2 Aneurysm exclusion.

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 3 Major complications.
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Analysis 1.3

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 3 Major complications.

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 4 Major complications (6 months).
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Analysis 1.4

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 4 Major complications (6 months).

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 5 Bleeding complications.
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Analysis 1.5

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 5 Bleeding complications.

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Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 6 Operating time (minutes).
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Analysis 1.6

Comparison 1 Percutaneous vs cut‐down femoral artery access, Outcome 6 Operating time (minutes).

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Summary of findings for the main comparison. Totally percutaneous compared to cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Totally percutaneous compared to cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Patient or population: people undergoing elective bifurcated abdominal endovascular aneurysm repair
Setting: hospital
Intervention: totally percutaneous
Comparison: cut‐down femoral artery access

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with cut‐down femoral artery access

Risk with totally percutaneous

Short‐term mortality rate

(30‐day or in‐hospital)

See comment

See comment

RR 1.50
(0.06 to 36.18)

181
(2 RCTs)

⊕⊕⊕⊝
MODERATE 1

It was not possible to calculate risk as only one event occurred. Note that although 2 RCTs included, only one contributes to effect estimate (no events in Torsello 2003)

Failure of aneurysm exclusion
(follow‐up 28 days)

Study population

RR 0.17 (0.01 to 4.02)

151
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

20 per 1000

3 per 1000
(0 to 80)

Wound infection rate (30‐day or in‐hospital)

See comment

See comment

not estimable

181
(2 RCTs)

⊕⊕⊕⊝
MODERATE 3

Risk and relative effect were not estimable as no events occurred

Major complications (30‐day or in‐hospital)

Study population

RR 0.91
(0.50 to 1.68)

181
(2 RCTs)

⊕⊕⊕⊝
MODERATE 4

200 per 1000

182 per 1000
(100 to 336)

Long term complications
(follow‐up 6 months)

Study population

RR 1.03
(0.34 to 3.15)

134
(1 RCT)

⊕⊕⊕⊝
MODERATE 5

95 per 1000

98 per 1000
(32 to 299)

Bleeding complications and haematoma

(30‐day or in‐hospital)

Study population

RR 0.94
(0.31 to 2.82)

181
(2 RCTs)

⊕⊕⊕⊕
HIGH

62 per 1000

58 per 1000
(19 to 174)

Operating time (minutes)

The mean operating time was 99 minutes

The mean operating time in the intervention group was 31.46 minutes lower (47.51 lower to 15.42 lower)

‐

181
(2 RCTs)

⊕⊕⊕⊝
MODERATE 6

* The basis for the assumed risk for 'Study population' was the average risk in the comparison group (i.e. total number of participants with events divided by the total number of participants in the comparison group included in the meta‐analysis. The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) and calculated where possible from the data provided in the studies.
CI: Confidence interval; mins: minutes; RCT: randomised controlled trial; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded by one level due to the low number of events and imprecision (wide confidence intervals include both harm and benefit)
2 We downgraded by one level as event rates were low and data were available from only one study
3 We downgraded by one level due to a low number of events (no wound infections reported)
4 We downgraded by one level due to imprecision (wide confidence intervals include both harm and benefit)
5 We downgraded by one level as data were available from only one study. A loss to follow up for this outcome was detected (9% of participants; 16% of the percutaneous group and 8% of the cut‐down femoral artery access group). We did not downgrade further as there was a clear breakdown of loss to follow‐up and no significant difference in loss to follow‐up between groups was detected
6 We downgraded by one level as the studies reported this outcome as a secondary outcome and were not adequately powered for this outcome.

Figuras y tablas -
Summary of findings for the main comparison. Totally percutaneous compared to cut‐down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair
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Comparison 1. Percutaneous vs cut‐down femoral artery access

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality rate (30‐day or in‐hospital) Show forest plot

2

181

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.06, 36.18]

2 Aneurysm exclusion Show forest plot

1

151

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 4.02]

3 Major complications Show forest plot

2

181

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.50, 1.68]

4 Major complications (6 months) Show forest plot

1

134

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.34, 3.15]

5 Bleeding complications Show forest plot

2

181

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.31, 2.82]

6 Operating time (minutes) Show forest plot

2

181

Mean Difference (IV, Fixed, 95% CI)

‐31.46 [‐47.51, ‐15.42]
Figuras y tablas -
Comparison 1. Percutaneous vs cut‐down femoral artery access
Ir a la tabla de la revisión