血管内与外科血管重建术治疗慢性肠系膜缺血
Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia.
作者信息
Saedon Mahmud, Saratzis Athanasios, Karim Ahmed, Goodyear Steve
机构信息
Division of Metabolic and Vascular Health, University of Warwick, Coventry, United Kingdom West Midlands Vascular Society, West Midlands, United Kingdom.
West Midlands Vascular Society, West Midlands, United Kingdom Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry, United Kingdom
出版信息
Vasc Endovascular Surg. 2015 Jan-Feb;49(1-2):37-44. doi: 10.1177/1538574415585127. Epub 2015 May 11.
BACKGROUND
Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization (SR) or endovascular revascularization (ER).
MATERIALS AND METHODS
Systematic review of 12 studies comparing ER and SR in CMI. Primary end point was perioperative (30 days) survival. A secondary composite end point consisted of perioperative mortality, nonfatal cardiac events, nonfatal stroke, and nonfatal bowel ischemia. Further end points included late survival, primary patency, and symptom improvement.
RESULTS
The cumulative odds ratio (OR) for perioperative mortality was 0.78 (95% confidence interval [CI]: 0.40-1.50, P = .45) and 0.56 (95% CI: 0.28-1.11, P = .10) for the composite end point. The cumulative OR for survival after the 30th day was 0.83 (95% CI: 0.47-1.46), P = .51. Late primary patency was reported in 8 studies, with a cumulative OR of 3.57 (95% CI: 1.83-6.97, P = .0002)-favoring SR.
CONCLUSION
In the first meta-analysis to compare ER and SR in CMI, there were no differences in mortality and morbidity. Patency rates were better following SR.
背景
慢性肠系膜缺血（CMI）可通过外科血管重建术（SR）或血管腔内血管重建术（ER）进行治疗。
材料与方法
对12项比较CMI患者ER与SR的研究进行系统评价。主要终点是围手术期（30天）生存率。次要复合终点包括围手术期死亡率、非致命性心脏事件、非致命性中风和非致命性肠缺血。其他终点包括远期生存率、原发性通畅率和症状改善情况。
结果
围手术期死亡率的累积比值比（OR）为0.78（95%置信区间[CI]：0.40 - 1.50，P = 0.45），复合终点的累积比值比为0.56（95%CI：0.28 - 1.11，P = 0.10）。第30天后生存率的累积OR为0.83（95%CI：0.47 - 1.46），P = 0.51。8项研究报告了远期原发性通畅率，累积OR为3.57（95%CI：1.83 - 6.97，P = 0.0002），支持SR。
结论
在第一项比较CMI患者ER与SR的荟萃分析中，死亡率和发病率无差异。SR后的通畅率更好。
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