Department of Vascular and Endovascular Surgery, Morriston Hospital, Swansea, UK.
Br J Surg. 2012 Sep;99(9):1195-202. doi: 10.1002/bjs.8811. Epub 2012 May 22.
The aim was to investigate the possible benefit of vein cuffs for femoral to below-knee popliteal and femorodistal vessel synthetic bypass grafts.
PubMed, the Cochrane library, Embase and ClinicalTrials.gov were searched for all studies on any clinical effect of vein cuffs on synthetic grafts. Outcomes were selected based on inclusion in two or more studies: primary patency and limb survival. The data were subjected to meta-analysis by outcome.
Three cohort and two randomized studies were selected for inclusion, involving 885 patients. Meta-analysis of five studies examining below-knee popliteal bypass showed a significant improvement for primary patency in cuffed grafts at 2 years, but not at 1 or 3 years (odds ratio at 2 years 0·46, 95 per cent confidence interval 0·22 to 0·97; P = 0·04). Limb salvage was significantly improved in cuffed grafts up to 2 years. Limb survival was also improved for cuffed distal grafts at 2 years (odds ratio 0·29, 0·11 to 0·75; P = 0·01) but showed no difference at any other time interval. Study quality was generally poor, with conflicting results.
There was a small but significant benefit for vein cuffs on synthetic grafts used for femoral to below-knee popliteal anastomoses, but little benefit for femorodistal anastomoses.
本研究旨在探讨使用血管套袖对股腘下膝下及股胫远侧人造血管旁路移植术的可能益处。
检索了 PubMed、Cochrane 图书馆、Embase 和 ClinicalTrials.gov 上所有关于血管套袖对人造移植物任何临床效果的研究。根据两项或多项研究纳入的结果选择结局：一期通畅率和肢体存活率。对数据进行了基于结局的荟萃分析。
纳入了 3 项队列研究和 2 项随机研究，共 885 例患者。对 5 项研究的荟萃分析表明，在膝下腘动脉旁路移植术中，使用血管套袖的一期通畅率在 2 年时显著提高，但在 1 年和 3 年时没有显著提高（2 年时的优势比为 0.46，95%置信区间为 0.22 至 0.97；P=0.04）。在 2 年内，使用血管套袖可显著提高保肢率。使用血管套袖的远侧股胫人造血管旁路移植术的肢体存活率在 2 年时也得到了改善（优势比为 0.29，0.11 至 0.75；P=0.01），但在其他任何时间间隔都没有差异。研究质量普遍较差，结果相互矛盾。
血管套袖对股腘下膝下吻合的人造血管旁路移植术有较小但显著的益处，但对股胫远侧吻合术益处不大。
