The review concluded that endovascular treatment with fenestrated and/or branched stent-grafts had encouraging results for patients with thoracoabdominal aortic aneurysms considered unfit for conventional open surgery. Further research was needed. Some methodological problems with the review and concerns about the study data limit the reliability of the authors’ results. However, the conclusions were suitably cautious and appear appropriate.

To review the use of fenestrated and branched stent-grafts in patients with thoracoabdominal aortic aneurysms (TAAA).

PubMed was searched from January 2000 to September 2009 for articles published in English. Search terms were reported. Reference lists of relevant reviews and studies were searched.

Studies of fenestrated and/or branched endografts in high-risk patients with a diagnosis of TAAA were eligible for inclusion. Studies had to include more than three patients and provide data on patient demographics, follow-up length, technical success and 30-day mortality. Studies on juxtarenal aneurysm repair and studies that specialised in conventional open surgery or less invasive techniques were excluded.

The included studies were mostly conducted in patients with aneurysms classified as Crawford type IV and had aneurysm sizes of between 6.5cm and 7.6cm. Types of intervention were custom-designed branched and/or fenestrated endovascular devices based on the Zenith endograft. Mean patient age was 71 to 76 years. The proportion of male patients was approximately 65%. Many of the patients had comorbidities such as coronary artery disease, hypertension, diabetes, COPD, renal failure and previous surgery.

Three reviewers independently undertook study selection. Disagreements were resolved by discussion.

The authors did not state that validity was assessed.

Data was extracted on technical success, mortality, complications and endoleaks. The authors did not state how many reviewers performed data extraction.

A narrative synthesis was presented, grouped by type of outcome.

Seven case series were included in the review (n=155 patients). Study sample sizes ranged from four to 73 patients. Mean length of follow-up was 11.8 months.

Across the seven studies, mean technical success was 94% (range 75% to 100%), 30-day mortality rate was 7% (0% to 25%) and one-year survival rate was 83% (73% to 100%). The rate of primary endoleaks was 18.4%. Risk of renal failure was 6%. The rate of paraplegia was 2.6% and rate of paraparesis was 7.1%. Other outcomes were reported.

Endovascular treatment with fenestrated and/or branched stent-grafts had encouraging results for patients considered unfit for conventional open surgery. Further research was needed.

Inclusion criteria for the review were clearly defined. One relevant database was searched. There was potential for language bias, as only English-language studies were included. Publication bias was not assessed and could not be ruled out. Attempts were made to reduce reviewer error and bias during study selection; it was unclear whether this was the case for data extraction. Quality assessment was not reported; as all the included studies were case-series with small sample sizes, the risk of biases within the studies was high. Studies were narratively synthesised, which appeared appropriate for this type of data.

Some methodological problems with the review and concerns about the study data limit the reliability of the authors’ results. However, the conclusions were suitably cautious and appear appropriate.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research on fenestrated and/or branched stent-grafts or hybrid procedures with longer-follow up periods was needed.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.