MEDLINE, EMBASE, and Cochrane Library were searched for studies reporting coverage of CA during TEVAR. The methodological quality of included studies was assessed by means of the Moga-Score and Newcastle-Ottawa scale. Random-effects model was used to pool estimates. A meta-analysis was performed with investigation of the following outcomes: visceral ischemia, spinal cord ischemia (SCI), stroke, endoleaks, reintervention, 30-day mortality and 1-year mortality.
Ten studies with 171 patients were included. The summary estimate rate of visceral ischemia events was 4.2% (95% CI, 0.9-8.9%; I =4.1%). The incidences of stroke and SCI were 0.2% (95% CI, 0-3.4%; I=0%) and 3% (95% CI, 0.3-7.4%; I =6.1%). The rate of endoleak during the follow-up period was 24.1% (95% CI, 14.3-35.1%; I=20.0%). Furthermore, reintervention rate was 13.6% (95% CI, 4.4-25.7; I=66.0%). The 30-day and 1-year mortality were 2.9% (95% CI, 0.3-7.2%; I=6.2%) and 15.2% (95% CI, 7.8-23.9%; I=0%).
Among the patients with complex thoracic aortic pathologies deemed at high risk for open reconstruction, TEVAR with intentional coverage of CA is a safe and feasible option to extend the distal sealing zone with acceptable rates of visceral ischemia, SCI, type II endoleak from the CA and 30-day mortality.