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动脉切除术 - - 选择,证据,以及何时应该使用它

Paula Pinto¹, Cassius Iyad Ochoa Chaar¹

¹Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT, USA.

Annals of vascular surgery

|April 7, 2024

概括

在外周血管干预 (PVIs) 中,瘤切除术的使用量急剧增加,但对其优于其他技术的证据缺乏. 它的应用应该是有选择的,以患者的需要和从业人员的专业知识为指导.

科学领域:

心血管医学心血管医学
干预心脏病学干预心脏病学
血管外科血管外科

背景情况:

在外周血管干预 (PVI) 中,动脉切除术的使用量显著增加,现在占美国手术的18%.
该技术旨在修改和去除动脉斑块,理论上有利于广泛的化.
目前支持切除术优于其他内血管方法的证据有限.

研究的目的:

审查目前在PVIs使用atherctomy的情况.
评估证据,比较不同的切除术技术.
讨论在复杂动脉样硬化病变中切除动脉的适当和选择性应用.

主要方法:

对外围血管干预中神经切除术现有文献的综述.
对前性比较研究的分析,注意到患者数量和疾病严重程度的局限性.
检查有关剖析风险和救助支架支架率的现有数据.

主要成果:

没有任何前性研究直接比较各种atherctomy技术 (定向,旋转,轨道,激光).
现有的比较研究往往涉及小患者队列或专注于轻度至中度疾病.
虽然报告了较低的剖析和救助支架率,但其优越性比其他内血管技术仍然未被证明.

结论:

切除术的使用增加,可能是由于补偿,可能导致过度使用作为一线治疗.
动脉切除术应选择性地使用,并与其他内血管方法相补充.
个性化患者评估和从业人员的专业知识对于管理复杂动脉样硬化病变的最佳决策至关重要.

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