Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis

A Meta-analysis

Jae Hyun Jung, Young Ho Lee, Gwan Gyu Song, Han Saem Jeong, Jae Hoon Kim, Sungjae Choi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective/Background: Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. Methods: A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I2 statistic. Results: The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78–9.62; p < .001). In subgroup analysis according to the involved lesions, endovascular intervention patients showed more restenosis than open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12–0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. Conclusion: This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.

Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Takayasu Arteritis
Meta-Analysis
Stroke
Renal Artery
Odds Ratio
Confidence Intervals
Mortality
MEDLINE
Observational Studies
Coronary Vessels
Hypertension
Therapeutics

Keywords

  • Endovascular
  • Intervention
  • Open surgical
  • Restenosis
  • Stroke
  • Takayasu's arteritis

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{f13ce31280294a7a9d62582fba8b4aa7,
title = "Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis",
abstract = "Objective/Background: Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. Methods: A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I2 statistic. Results: The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95{\%} confidence interval [CI] 2.78–9.62; p < .001). In subgroup analysis according to the involved lesions, endovascular intervention patients showed more restenosis than open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95{\%} CI 0.12–0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. Conclusion: This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.",
keywords = "Endovascular, Intervention, Open surgical, Restenosis, Stroke, Takayasu's arteritis",
author = "Jung, {Jae Hyun} and Lee, {Young Ho} and Song, {Gwan Gyu} and Jeong, {Han Saem} and Kim, {Jae Hoon} and Sungjae Choi",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ejvs.2018.02.030",
language = "English",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",

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T1 - Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis

T2 - A Meta-analysis

AU - Jung, Jae Hyun

AU - Lee, Young Ho

AU - Song, Gwan Gyu

AU - Jeong, Han Saem

AU - Kim, Jae Hoon

AU - Choi, Sungjae

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective/Background: Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. Methods: A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I2 statistic. Results: The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78–9.62; p < .001). In subgroup analysis according to the involved lesions, endovascular intervention patients showed more restenosis than open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12–0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. Conclusion: This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.

AB - Objective/Background: Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. Methods: A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I2 statistic. Results: The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78–9.62; p < .001). In subgroup analysis according to the involved lesions, endovascular intervention patients showed more restenosis than open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12–0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. Conclusion: This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.

KW - Endovascular

KW - Intervention

KW - Open surgical

KW - Restenosis

KW - Stroke

KW - Takayasu's arteritis

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