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The Impact of Aortic Occlusion Balloon on Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Meta-analysis and Meta-regression Analysis

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Abstract

Introduction

We aimed to investigate whether the use of aortic occlusion balloon (AOB) has an impact on mortality of patients undergoing endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).

Methods

A meta-analysis of the English-language literature was undertaken through February 2013. Articles reporting data on outcome after endovascular repair of RAAAs were identified and information regarding the use of AOB was sought.

Results

Included in this meta-analysis were 39 eligible studies reporting 1277 patients. The pooled perioperative mortality was 21.6 % (95 % CI 18.1–25.1 %). There was significant within-study heterogeneity (I 2 50.2 %, P < 0.001). A total of 200 patients required AOB with an estimated pooled proportion of 14.1 % (8.9–19.3 %). Individual random-effects meta-regression investigating the effect of AOB and other risk factors on mortality revealed a significant linear association of hemodynamic instability, bifurcated endograft approach, and primary conversion to open repair with mortality and a nonlinear (second degree polynomial) association of AOB with mortality. On multivariable meta-regression models, both hemodynamic instability and AOB were found to be statistically significant, independent predictors of mortality. In particular, there was a statistically significant negative correlation between AOB and mortality and a positive effect of hemodynamic instability on mortality. In practical terms, mortality was significantly higher in studies with a higher proportion of hemodynamically unstable patients and lower in studies with a higher rate of AOB use.

Conclusion

This study provides meta-analytical evidence that the use of an AOB in unstable RAAA patients undergoing endovascular repair may improve the results.

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Conflict of interest

Christos D. Karkos declares no conflicts of interest, Christina T. Papadimitriou declares no conflicts of interest, Theodoros N. Chatzivasileiadis declares no conflicts of interest, Nikoletta S. Kapsali declares no conflicts of interest, Thomas E. Kalogirou declares no conflicts of interest, Ioakeim T. Giagtzidis declares no conflicts of interest, Konstantinos O. Papazoglou declares no conflicts of interest.

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Authors and Affiliations

  1. 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece

    Christos D. Karkos, Christina T. Papadimitriou, Thomas E. Kalogirou, Ioakeim T. Giagtzidis & Konstantinos O. Papazoglou

  2. Institute for Environmental Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Theodoros N. Chatzivasileiadis

  3. Health Economist/Statistical Programmer, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands

    Nikoletta S. Kapsali

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  1. Christos D. Karkos
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Karkos, C.D., Papadimitriou, C.T., Chatzivasileiadis, T.N. et al. The Impact of Aortic Occlusion Balloon on Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Meta-analysis and Meta-regression Analysis. Cardiovasc Intervent Radiol 38, 1425–1437 (2015). https://doi.org/10.1007/s00270-015-1132-1

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