Romiti Marcello, Albers Maximiano, Brochado-Neto Francisco Cardoso, Durazzo Anai Espinelli S, Pereira Carlos Alberto Bragança, De Luccia Nelson
Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada Foundation, Santos, Sao Paulo, Brazil.
J Vasc Surg. 2008 May;47(5):975-981. doi: 10.1016/j.jvs.2008.01.005. Epub 2008 Apr 18.
Percutaneous transluminal angioplasty has been used with increasing frequency in the treatment of infrainguinal arterial occlusive disease. This meta-analysis aimed to assess the middle-term outcomes after crural angioplasty in patients with chronic critical limb ischemia and compare results with a meta-analysis of popliteal-to-distal vein bypass graft.
Data were retrieved from 30 articles published from 1990 through 2006 (63% of articles published between 2000 and 2006). All studies used survival analysis, reported a 12-month cumulative rate of patency or limb salvage, and included at least 15 infrapopliteal angioplasties. The outcome measures were immediate technical success, primary and secondary patency, limb salvage, and patient survival. Data from life-tables, survival curves, and texts were used.
The pooled estimate of success was 89.0% +/- 2.2% for immediate technical result. Results at 1 and 36 months were 77.4% +/- 4.1% and 48.6% +/- 8.0% for primary patency, 83.3% +/- 1.4% and 62.9% +/- 11.0% for secondary patency, 93.4% +/- 2.3% and 82.4% +/- 3.4% for limb salvage, and 98.3% +/- 0.7% and 68.4% +/- 5.5% for patient survival, respectively. Studies with >75% of the limbs with tissue loss fared worse than their respective comparative subgroup for technical success and patency but not for limb salvage or survival. No publication bias was detected.
The technical success and subsequent durability of crural angioplasty are limited compared with bypass surgery, but the clinical benefit is acceptable because limb salvage rates are equivalent to bypass surgery. Further studies are necessary to determine the proper role of infrapopliteal angioplasty.
经皮腔内血管成形术在治疗股动脉以下动脉闭塞性疾病中的应用频率日益增加。本荟萃分析旨在评估慢性严重肢体缺血患者小腿血管成形术后的中期疗效，并与腘动脉至远端静脉旁路移植术的荟萃分析结果进行比较。
数据取自1990年至2006年发表的30篇文章（2000年至2006年发表文章的63%）。所有研究均采用生存分析，报告了12个月的通畅率或肢体挽救累积率，且至少纳入了15例腘动脉以下血管成形术。观察指标为即刻技术成功率、原发性和继发性通畅率、肢体挽救率及患者生存率。使用了来自生命表、生存曲线及文本的数据。
即刻技术结果的成功合并估计值为89.0%±2.2%。1个月和36个月时，原发性通畅率分别为77.4%±4.1%和48.6%±8.0%，继发性通畅率分别为83.3%±1.4%和62.9%±11.0%，肢体挽救率分别为93.4%±2.3%和82.4%±3.4%，患者生存率分别为98.3%±0.7%和68.4%±5.5%。组织丢失肢体比例超过75%的研究在技术成功率和通畅率方面比各自的比较亚组差，但在肢体挽救率或生存率方面并非如此。未检测到发表偏倚。
与旁路手术相比，小腿血管成形术的技术成功率和后续耐久性有限，但临床获益尚可接受，因为肢体挽救率与旁路手术相当。有必要进行进一步研究以确定腘动脉以下血管成形术的恰当作用。
