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Editor's Choice - Branched Endovascular Aneurysm Repair with Inner and Outer Branches : A Systematic Review and Meta-analysis

Karelis, Angelos LU orcid ; Kölbel, Tilo LU ; Mastracci, Tara ; Katsargyris, Athanasios ; Haulon, Stephan ; Tsilimparis, Nikolaos and Antoniou, George A (2025) In European Journal of Vascular and Endovascular Surgery 70(1). p.34-43
Abstract

OBJECTIVE: This systematic review aimed to assess the clinical outcomes of branched endovascular aneurysm repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR).

DATA SOURCES: A systematic literature review was performed using the electronic bibliographic databases MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2024.

REVIEW METHODS: The review was designed and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported death, technical failure, primary target vessel (TV) patency, TV related complications, branch related re-interventions, and spinal cord ischaemia (SCI). Risk of bias was... (More)

OBJECTIVE: This systematic review aimed to assess the clinical outcomes of branched endovascular aneurysm repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR).

DATA SOURCES: A systematic literature review was performed using the electronic bibliographic databases MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2024.

REVIEW METHODS: The review was designed and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported death, technical failure, primary target vessel (TV) patency, TV related complications, branch related re-interventions, and spinal cord ischaemia (SCI). Risk of bias was evaluated with the ROBINS-I tool.

RESULTS: Twenty seven observational studies reporting a total of 1 780 patients treated with BEVAR and 6 633 TVs were included. Three hundred and eightysix patients (84.3%) were treated electively with iBEVAR and 72 (15.6%) urgently vs. 845 (63.2%) and 491 (36.7%) with oBEVAR, respectively. The pooled estimate of 30 day death was 4.9% (95% confidence interval [CI] 2.9 - 8.2%) for iBEVAR and 7.6% (95% CI 4.9 - 11.7%) for oBEVAR. Overall mortality rates were 13.8% (95% CI 9.7 - 19.1%) for iBEVAR vs. 15.4% (95% CI 10.6 - 21.9%) for oBEVAR. The rate of SCI was 6.5% (95% CI 4.2 - 10.0%) in iBEVAR compared with 12.9% (95% CI 9.6 - 17.1%) in oBEVAR. Primary TV patency was similar between iBEVAR (97.3%, 95% CI 94.8 - 98.6%) and oBEVAR (97.6%, 95% CI 95.3 - 98.7%). TV related complication rates were 2.9% (95% CI 2.0 - 4.1%) for iBEVAR vs. 3.9% (95% CI 2.7 - 5.6%) for oBEVAR. Technical failure rates were 4.1% (95% CI 2.4 - 6.9%) for iBEVAR vs. 5.7% (95% CI 3.5 - 9.1%) for oBEVAR. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty was low or very low for all outcomes.

CONCLUSION: BEVAR with inner and inner/outer branches has been used in elective and urgent cases, as well as across a variety of anatomies, with both designs demonstrating satisfactory clinical outcomes.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Aortic Aneurysm, Abdominal/surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Endovascular Aneurysm Repair, Endovascular Procedures/methods, Postoperative Complications/epidemiology, Prosthesis Design, Treatment Outcome
in
European Journal of Vascular and Endovascular Surgery
volume
70
issue
1
pages
34 - 43
publisher
Elsevier
external identifiers
  • scopus:105004476410
  • pmid:40064233
ISSN
1532-2165
DOI
10.1016/j.ejvs.2025.03.003
language
English
LU publication?
yes
additional info
Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.
id
a0ea5118-2f9e-4e4b-8912-8e646ef3547e
date added to LUP
2025-08-17 14:21:39
date last changed
2025-08-18 08:48:08
@article{a0ea5118-2f9e-4e4b-8912-8e646ef3547e,
  abstract     = {{<p>OBJECTIVE: This systematic review aimed to assess the clinical outcomes of branched endovascular aneurysm repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR).</p><p>DATA SOURCES: A systematic literature review was performed using the electronic bibliographic databases MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2024.</p><p>REVIEW METHODS: The review was designed and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported death, technical failure, primary target vessel (TV) patency, TV related complications, branch related re-interventions, and spinal cord ischaemia (SCI). Risk of bias was evaluated with the ROBINS-I tool.</p><p>RESULTS: Twenty seven observational studies reporting a total of 1 780 patients treated with BEVAR and 6 633 TVs were included. Three hundred and eightysix patients (84.3%) were treated electively with iBEVAR and 72 (15.6%) urgently vs. 845 (63.2%) and 491 (36.7%) with oBEVAR, respectively. The pooled estimate of 30 day death was 4.9% (95% confidence interval [CI] 2.9 - 8.2%) for iBEVAR and 7.6% (95% CI 4.9 - 11.7%) for oBEVAR. Overall mortality rates were 13.8% (95% CI 9.7 - 19.1%) for iBEVAR vs. 15.4% (95% CI 10.6 - 21.9%) for oBEVAR. The rate of SCI was 6.5% (95% CI 4.2 - 10.0%) in iBEVAR compared with 12.9% (95% CI 9.6 - 17.1%) in oBEVAR. Primary TV patency was similar between iBEVAR (97.3%, 95% CI 94.8 - 98.6%) and oBEVAR (97.6%, 95% CI 95.3 - 98.7%). TV related complication rates were 2.9% (95% CI 2.0 - 4.1%) for iBEVAR vs. 3.9% (95% CI 2.7 - 5.6%) for oBEVAR. Technical failure rates were 4.1% (95% CI 2.4 - 6.9%) for iBEVAR vs. 5.7% (95% CI 3.5 - 9.1%) for oBEVAR. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty was low or very low for all outcomes.</p><p>CONCLUSION: BEVAR with inner and inner/outer branches has been used in elective and urgent cases, as well as across a variety of anatomies, with both designs demonstrating satisfactory clinical outcomes.</p>}},
  author       = {{Karelis, Angelos and Kölbel, Tilo and Mastracci, Tara and Katsargyris, Athanasios and Haulon, Stephan and Tsilimparis, Nikolaos and Antoniou, George A}},
  issn         = {{1532-2165}},
  keywords     = {{Humans; Aortic Aneurysm, Abdominal/surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation/adverse effects; Endovascular Aneurysm Repair; Endovascular Procedures/methods; Postoperative Complications/epidemiology; Prosthesis Design; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{34--43}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Vascular and Endovascular Surgery}},
  title        = {{Editor's Choice - Branched Endovascular Aneurysm Repair with Inner and Outer Branches : A Systematic Review and Meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2025.03.003}},
  doi          = {{10.1016/j.ejvs.2025.03.003}},
  volume       = {{70}},
  year         = {{2025}},
}