Endovascular aortic repair is an emerging novel intervention for the management of abdominal aortic aneurysms. It is crucial to compare the effectiveness of different access sites, such as transfemoral access (TFA) and upper extremity access (UEA). An electronic literature search was conducted using PubMed, EMBASE, and Google Scholar databases. The primary endpoint was the incidence of stroke/transient ischemic attack (TIA), while the secondary endpoints included technical success, access-site complications, mortality, myocardial infarction (MI), spinal cord ischemia, among others. Forest plots were constructed for the pooled analysis of data using the random-effects model in Review Manager, version 5.4. Statistical significance was set at p < 0.05. Our findings in 9403 study participants (6228 in the TFA group and 3175 in the UEA group) indicate that TFA is associated with a lower risk of stroke/TIA [RR: 0.55; 95% CI: 0.40–0.75; p = 0.0002], MI [RR: 0.51; 95% CI: 0.38–0.69; p < 0.0001], spinal cord ischemia [RR: 0.41; 95% CI: 0.32–0.53, p < 0.00001], and shortens fluoroscopy time [SMD: −0.62; 95% CI: −1.00 to −0.24; p = 0.001]. Moreover, TFA required less contrast agent [SMD: −0.33; 95% CI: −0.61 to −0.06; p = 0.02], contributing to its appeal. However, no significant differences emerged in technical success [p = 0.23], 30-day mortality [p = 0.48], ICU stay duration [p = 0.09], or overall hospital stay length [p = 0.22]. Patients with TFA had a lower risk of stroke, MI, and spinal cord ischemia, shorter fluoroscopy time, and lower use of contrast agents. Future large-scale randomized controlled trials are warranted to confirm and strengthen these findings.

中文翻译：

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接受血管内主动脉修复术的患者经股动脉入路和经股动脉入路辅助上肢入路的结果比较：初步系统评价和荟萃分析

主动脉腔内修复术是一种新兴的治疗腹主动脉瘤的新型干预措施。比较不同接入点的有效性至关重要，例如经股动脉接入 (TFA) 和上肢接入 (UEA)。使用 PubMed、EMBASE 和 Google Scholar 数据库进行电子文献检索。主要终点是中风/短暂性脑缺血发作（TIA）的发生率，次要终点包括技术成功、穿刺部位并发症、死亡率、心肌梗死（MI）、脊髓缺血等。使用 Review Manager 5.4 版中的随机效应模型构建森林图，用于数据汇总分析。统计显着性设定为p  < 0.05。我们对 9403 名研究参与者（TFA 组 6228 名，UEA 组 3175 名）的研究结果表明，TFA 与较低的中风/TIA 风险相关[RR：0.55；RR：0.55；RR：0.55]。 95% CI：0.40–0.75；p  = 0.0002]，MI [RR：0.51； 95% CI：0.38–0.69；p  < 0.0001]，脊髓缺血 [RR：0.41； 95% CI：0.32–0.53，p  < 0.00001]，并缩短透视时间 [SMD：-0.62； 95% CI：-1.00至-0.24；p  = 0.001]。此外，TFA 需要较少的造影剂[SMD：-0.33； 95% CI：-0.61至-0.06；p  = 0.02]，从而增强了其吸引力。然而，在技术成功率 [ p  = 0.23]、30 天死亡率 [ p  = 0.48]、ICU 住院时间 [ p  = 0.09] 或总体住院时间 [ p  = 0.22] 方面没有出现显着差异。 TFA 患者发生中风、心肌梗死和脊髓缺血的风险较低，透视时间较短，造影剂的使用较少。未来的大规模随机对照试验有必要证实和加强这些发现。