Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Vasc Surg. 2014 Jun;59(6):1711-20. doi: 10.1016/j.jvs.2014.03.012.
Percutaneous transluminal angioplasty (PTA) and primary stenting are commonly used endovascular therapeutic procedures for the treatment of infrapopliteal arterial occlusive disease. However, which procedure is more beneficial for patients with infrapopliteal arterial occlusive disease is unknown.
We performed a meta-analysis, searching PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, and relevant websites without language or publication date restrictions for randomized trials that compared primary stenting with PTA in patients with infrapopliteal arterial occlusive disease. The keywords were "stents," "angioplasty," "infrapopliteal," "tibial arteries," and "below knee." We selected immediate technical success, primary and secondary patency, limb salvage, and patient survival as the outcomes of this meta-analysis. On the basis of the inclusion criteria, we identified six prospective randomized trials. One-year outcomes did not show any significant differences between the PTA and primary stenting groups, respectively: technical success (93.3% vs 96.2%; odds ratio [OR], 0.59; 95% confidence interval [CI], 0.24-1.47; P = .25), primary patency (57.1% vs 65.7%; OR, 0.95; 95% CI, 0.35-2.58; P = .92), secondary patency (73.5% vs 57.6%; OR, 2.08; 95% CI, 0.81-5.34; P = .13), limb salvage (82.2% vs 87.5%; OR, 0.64; 95% CI, 0.29-1.41; P = .27), and patient survival (84.0% vs 87.5%; OR, 0.79; 95% CI, 0.40-1.55; P = .49).
For infrapopliteal arterial occlusive disease, primary stenting has the same 1-year benefits as PTA. There is insufficient evidence to support the superiority of either method. Primary stenting is associated with a trend toward higher primary patency and lower secondary patency. Further large-scale prospective randomized trials should produce more reliable results.
经皮腔内血管成形术（PTA）和一期支架置入术是治疗下肢动脉闭塞性疾病的常用血管内治疗方法。然而，对于下肢动脉闭塞性疾病患者，哪种方法更有益尚不清楚。
我们进行了一项荟萃分析，检索了 PubMed、EMBASE、Cochrane 对照试验中心注册库、ISI Web of Knowledge 和相关网站，未对纳入的随机试验设定语言或发表日期限制，这些试验比较了下肢动脉闭塞性疾病患者中一期支架置入术与 PTA 的疗效。关键词为“支架”、“血管成形术”、“下肢动脉”、“胫动脉”和“膝下”。我们选择即刻技术成功率、一期和二期通畅率、保肢率和患者生存率作为本荟萃分析的结局指标。根据纳入标准，我们确定了 6 项前瞻性随机试验。1 年随访结果显示 PTA 组与一期支架置入组之间没有显著差异：即刻技术成功率（93.3% vs 96.2%；比值比[OR]，0.59；95%置信区间[CI]，0.24-1.47；P =.25）、一期通畅率（57.1% vs 65.7%；OR，0.95；95% CI，0.35-2.58；P =.92）、二期通畅率（73.5% vs 57.6%；OR，2.08；95% CI，0.81-5.34；P =.13）、保肢率（82.2% vs 87.5%；OR，0.64；95% CI，0.29-1.41；P =.27）和患者生存率（84.0% vs 87.5%；OR，0.79；95% CI，0.40-1.55；P =.49）。
对于下肢动脉闭塞性疾病，一期支架置入术与 PTA 具有相同的 1 年获益。目前尚无足够证据支持哪种方法具有优势。一期支架置入术与较高的一期通畅率和较低的二期通畅率相关。需要进一步开展大规模前瞻性随机试验以获得更可靠的结果。
