Fahner Peter J, Idu Mirza M, van Gulik Thomas M, Legemate Dink A
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Vasc Surg. 2006 Sep;44(3):518-24. doi: 10.1016/j.jvs.2006.05.037.
We systematically reviewed clinical studies on the use of venous and arterial allografts for infrainguinal revascularization. We attempted to find evidence for the best infrainguinal vascular allograft by a systematic review of the available literature.
An electronic search of the MEDLINE, EMBASE, and Cochrane databases was used to determine key articles from studies on the different types of vascular allografts used in infrainguinal reconstruction from 1966 to 2004. Articles were independently reviewed by using previously defined inclusion and exclusion criteria. Study results were gathered with cumulative primary patency as the primary end point. Secondary end points were major complications, graft disintegration, and major limb loss. Quantitative analysis was performed on the prospective randomized trials, and linear regression analysis was performed on cumulative primary patency. Fontaine's classification system was applied.
No systematic review of randomized controlled trials was found. Five randomized controlled trials, 3 prospective cohort or case series, and 15 retrospective case series with 3,837 vascular allografts were found. Methods of allograft preservation were cryopreservation (5 studies), cold storage (3 studies), and glutaraldehyde preservation of human umbilical veins (15 studies). One-year cumulative primary patency rates were 13% to 79% for cryopreservation, 63% to 80% for cold storage, and 40% to 91% for glutaraldehyde. The weighted mean 1-year cumulative primary graft patency rate was 41% for cryopreservation, 71% for cold storage, and 70% for glutaraldehyde allografts. Four randomized trials on femoropopliteal bypasses demonstrated higher patency rates of glutaraldehyde-preserved human umbilical veins than polytetrafluoroethylene grafts. Statistical heterogeneity between studies (I(2) = 91.4%) was too high to perform a formal meta-analysis. The rate of major limb loss was 20% to 58% for cryopreservation, 10% to 69% for cold storage, and 0% to 65% for glutaraldehyde, and the percentage of graft disintegration was 2% to 6% for cryopreservation, 4% to 15% for cold storage, and 0% to 11% for glutaraldehyde.
A firm conclusion could not be made because there were no studies available in which direct comparison was performed between different preservation methods of vascular allografts. In addition, heterogeneity of the individual studies hampered direct comparison of different types of vascular allografts. However, the overall graft performance of glutaraldehyde-preserved human umbilical vein allografts may be superior to that of other vascular allografts.
我们系统回顾了关于使用静脉和动脉同种异体移植物进行腹股沟下血管重建的临床研究。我们试图通过对现有文献的系统回顾来寻找最佳腹股沟下血管同种异体移植物的证据。
通过对MEDLINE、EMBASE和Cochrane数据库进行电子检索，以确定1966年至2004年期间关于腹股沟下重建中使用的不同类型血管同种异体移植物的研究中的关键文章。使用先前定义的纳入和排除标准对文章进行独立评审。以累积原发性通畅率作为主要终点收集研究结果。次要终点为主要并发症、移植物崩解和主要肢体缺失。对前瞻性随机试验进行定量分析，对累积原发性通畅率进行线性回归分析。应用Fontaine分类系统。
未找到对随机对照试验的系统评价。发现了5项随机对照试验、3项前瞻性队列或病例系列以及15项回顾性病例系列，共涉及3837例血管同种异体移植物。同种异体移植物的保存方法有冷冻保存（5项研究）、冷藏（3项研究）和人脐静脉的戊二醛保存（15项研究）。冷冻保存的1年累积原发性通畅率为13%至79%，冷藏为63%至80%，戊二醛为40%至91%。冷冻保存的加权平均1年累积原发性移植物通畅率为41%，冷藏为71%，戊二醛同种异体移植物为70%。四项关于股腘动脉旁路移植的随机试验表明，戊二醛保存的人脐静脉移植物的通畅率高于聚四氟乙烯移植物。研究之间的统计异质性（I(2)=91.4%）过高，无法进行正式的荟萃分析。冷冻保存的主要肢体缺失率为20%至58%，冷藏为10%至69%，戊二醛为0%至65%，移植物崩解百分比冷冻保存为2%至6%，冷藏为4%至15%，戊二醛为0%至11%。
由于没有对血管同种异体移植物的不同保存方法进行直接比较的研究，因此无法得出确凿结论。此外，各研究的异质性阻碍了不同类型血管同种异体移植物的直接比较。然而，戊二醛保存的人脐静脉同种异体移植物的总体移植物性能可能优于其他血管同种异体移植物。
