下肢动脉疾病患者的内血管再血管化与开放式手术再血管化:系统性审查和元分析
Hongxin Shu1, Xiaowei Xiong2, Xiaomei Chen3
1The Second Clinical Medical School, Nanchang University, Nanchang, China.
Frontiers in cardiovascular medicine
|August 9, 2023
概括
内血管再血管 (EVR) 为下肢动脉疾病 (LEAD) 提供了较低的短期风险,而开放式手术再血管 (OSR) 提供了更好的长期结果. 在选择LEAD治疗时,患者的预期寿命至关重要.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 健康 结果 研究 研究 结果
背景情况:
- 下肢动脉疾病 (LEAD) 治疗主要涉及再血管,内血管再血管 (EVR) 和开放式手术再血管 (OSR) 是常见的模式.
- 对LEAD的最佳再血管化策略仍然是医学界持续辩论和争议的主题.
研究的目的:
- 提供对最近证据的综合审查,比较内血管再血管 (EVR) 和开放式外科再血管 (OSR) 治疗下肢动脉疾病 (LEAD).
- 分析和综合随机对照试验 (RCT) 和队列研究的数据,以告知LEAD管理的临床决策.
主要方法:
- 在Medline,Embase和Cochrane图书馆数据库中进行了系统的文献搜索.
- 包括的研究是随机对照试验 (RCT) 和队列研究,比较LEAD患者的EVR与OSR的短期和长期结果.
- 评估结果包括死亡率,截肢率,并发症,心血管事件,住院,存活率,再干预率和血管通透率.
主要成果:
- 分析了11个RCT和105个队列研究,涉及750,134名患者.
- 聚合的队列数据表明,EVR显著降低了30天死亡率,伤口并发症,MACE和LOS,但增加了OS,FFR,PP和SP的风险.
- 汇集的RCT数据显示,EVR与较低的30天死亡率,较少的伤口并发症和较短的LOS有关,但PP和SP的风险更高. 没有观察到30天大截肢或AFS的显著差异.
结论:
- 队列研究和RCT都表明,EVR为LEAD提供了较低的短期风险,而OSR显示长期风险明显较低.
- 在选择LEAD的重血管化方式时,应仔细考虑患者的预期寿命.
- 需要进一步进行高质量的研究来验证这些发现,因为目前的证据主要依赖于回顾性队列数据.
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