Albers Maximiano, Romiti Marcello, Brochado-Neto Francisco Cardoso, De Luccia Nelson, Pereira Carlos Alberto Bragança
Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada Foundation, Santos, Sao Paulo, Brazil.
J Vasc Surg. 2006 Mar;43(3):498-503. doi: 10.1016/j.jvs.2005.11.025.
Several studies have described the use of popliteal-to-distal bypass grafts, mostly in patients with diabetes mellitus who show tissue loss and represent a high-risk population. The study objective was to conduct meta-analysis to assess the long-term primary and secondary patency and foot preservation after popliteal-to-distal bypass grafts.
Data was retrieved from studies published from 1981 through 2004 that were identified from an electronic database. Thirty-one series that used survival analysis reported a 1-year graft patency rate and included at least 15 bypasses. Data from life tables, survival curves, and texts were used to calculate an interval success rate for each month in each series of grafts. Monthly success rates were combined across series to obtain a pooled estimate of success for each month, according to a random-effects protocol for meta-analysis. Pooled survival curves were then constructed for graft patency and foot preservation.
The 5-year pooled estimate +/- standard error was 63.1% +/- 4.3% for primary patency, 70.7% +/- 4.6% for secondary patency, and 77.7% +/- 4.3% for foot preservation. There was a superiority trend favoring reversed vein grafts and tibial bypasses that became more apparent in sensitivity analysis. No publication bias was detected.
The popliteal-to-distal vein bypass is a tool of high efficiency in the treatment of severe, chronic critical ischemia in the lower extremity.
多项研究描述了腘动脉至远端旁路移植术的应用，主要用于患有组织缺损且属于高危人群的糖尿病患者。本研究的目的是进行荟萃分析，以评估腘动脉至远端旁路移植术后的长期原发性和继发性通畅率以及足部保留情况。
从1981年至2004年发表的研究中检索数据，这些研究通过电子数据库识别。31个采用生存分析的系列报道了1年移植通畅率，且至少包括15例旁路移植术。来自生命表、生存曲线和文本的数据用于计算每个移植系列中每月的区间成功率。根据荟萃分析的随机效应方案，将各系列的每月成功率合并，以获得每个月成功率的汇总估计值。然后构建移植通畅率和足部保留情况的汇总生存曲线。
原发性通畅率的5年汇总估计值±标准误为63.1%±4.3%，继发性通畅率为70.7%±4.6%，足部保留率为77.7%±4.3%。在敏感性分析中，倾向于使用静脉翻转移植术和胫动脉旁路移植术的优势趋势更为明显。未检测到发表偏倚。
腘动脉至远端静脉旁路移植术是治疗下肢严重慢性严重缺血的高效手段。
