Comparison And Meta-analysis Of Percutaneous Femoral Artery Puncture And Incision In The Treatment Of Stanford Type B Aortic Dissection

Objective:Although patients with aortic dissection are not common diseases,once they have a very high fatality rate.Now,retroretrospective data of The First Affiliated Hospital of Gannan Medical University single center are collected and combined with evidence-based medicine to evaluate patients with Type B aortic dissection(TBAD)who have undergone femoral artery puncture and suture(Percutaneous endovascular aneurysm repair,PEVAR)or the difference in curative effect of Endovascular aortic repair with surgical common femoral cutdown(SEVAR)provides a scientific basis for clinical treatment of type B aortic dissection.Methods:Clinical information: 343 atients with Stanford type B aortic dissection who were diagnosed with endovascular therapy(EVAR)in The First Affiliated Hospital of Gannan Medical University from January 2016 to December 2021 were selected.After screening,282 patients were selected and106 cases were divided into PEVAR group(paste the piercing artery,and embed the proglide angiite suture,after the film bracket was successfully placed,the sewer suture artery)was used,and 176 cases were divided into PEVAR group(ranscathered,coating After the film bracket is placed,the silk suture artery and the layers of the tissue).Collecting general information incorporating patients,including men and women,diagnosis age,whether there is a variety of disease factors at the same time,including blood glucose,blood lipids,abnormal kidney function,high blood pressure,etc.,and whether there is a bad lifestyle for smoking and drinking.The general observation indicators during the perioperative period were collected: total hospitalization time,postoperative ICU time,postoperative hospitalization time,and blood transfusion volume due to bleeding caused by surgery.Surgical approach-related complications in the perioperative period were collected,including inguinal hematoma,bleeding at the puncture site,lymphatic leakage,infection,arteriovenous fistula,and paresthesias.Follow-up surgical approach-related complications: common femoral artery pseudoaneurysm,puncture arterial dissection,lower extremity ischemia,lower extremity deep vein thrombosis,etc.Meta-analysis: Search five databases including Pub Med,Cochrane Library,Wanfang,CNKI,VIP,etc.Languages are limited to Chinese and English.Chinese search terms are:(femoral artery OR incision OR percutaneous)AND((aorta OR intraluminal)OR EVAR OR TEVAR),etc.;English search terms include:(femoral artery OR cutdown OR perclos* OR preclos* OR percutan*)AND(aort* OR aneurysm* OR endograft* OR EVAR OR TEVAR)etc.Domestic and foreign documents consistent with the meta-analysis study during2015.06-2022.01 were searched.Two reviewers independently selected quality-qualified trials and extracted data,which were entered into Revmen5.4 software for analysis and re-study.Results:1.The conclusion of a retrospective survey in our center showed that the PEVAR had lower hospitalization costs,shorter operation time and postoperative hospital stay,and less overall incidence of postoperative complications.2.A total of 11 individual studies were included in the Meta-analysis.The results showed that: the total hospitalization days,operation duration,intraoperative bleeding and postoperative hospitalization days of the patients in the PEVAR group were significantly shorter.In terms of complications: PEVAR group puncture site chance of infection and lymphatic leakage are significantly lower than SEVAR group.Conclusion:The effect of PEVAR is generally consistent with SEVAR,but it can effectively shorten the postoperative hospital stay and medical cost,and reduce the occurrence of related complications.It has greater safety,efficacy and minimally invasiveness,and is more in line with the concept of rapid recovery advocated by modern medicine,and is worthy of clinical application.