Different stent graft types to repair thoracic aortic aneurysms

Background

An aneurysm is a localised widening of an artery. The thoracic aorta is the largest artery in the body, delivering blood from the heart to the arms and head. If an aneurysm occurs in the thoracic aorta it can expand and may rupture, resulting in death. Open surgery can treat these aneurysms, which involves opening the chest and placing an artificial graft over the widening. A new alternative treatment involves an artificial stent graft, delivered through an arterial blood vessel in the groin, fixed over the widening. This technique is called endovascular repair. There are many different types of stent grafts available. They differ in how they are inserted into/access the blood vessel, how they attach to the walls of the artery and the design and materials they are made from.

Study characteristics and key results

We searched for evidence directly comparing the different types of stent grafts in aneurysm repair (current until February 2015). This review found no evidence from randomised controlled trials to determine if any specific stent graft performs better than another type of stent graft. More research is required to help surgeons decide which specific type of stent graft to use.

Quality of the evidence

It was not possible to assess the quality of the evidence in the absence of studies eligible for inclusion in the review.

Authors' conclusions: 

Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. High quality RCTs evaluating stent graft types in thoracic endovascular aneurysm repair are required.

Read the full abstract...
Background: 

The UK prevalence of thoracic aneurysm is estimated at 10.4 per 100,000 person-years. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of thoracic aortic aneurysms involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. This is an update of the review first published in 2013.

Objectives: 

This review aimed to assess the different stent graft types for endovascular repair of thoracic aortic aneurysms.

Search strategy: 

The Cochrane Vascular Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2015) and the Cochrane Register of Studies CENTRAL (2015, Issue 1). Trial databases were searched by the TSC for details of ongoing and unpublished studies.

Selection criteria: 

All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of thoracic aortic aneurysms were sought without language restriction.

Data collection and analysis: 

Data collection and analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

Main results: 

No studies were identified that met the inclusion criteria. It was not possible to assess the quality of the evidence in the absence of studies eligible for inclusion in the review.

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