Leake Andrew E, Segal Michael A, Chaer Rabih A, Eslami Mohammad H, Al-Khoury Georges, Makaroun Michel S, Avgerinos Efthymios D
Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg. 2017 Jan;65(1):246-256.e2. doi: 10.1016/j.jvs.2016.09.029.
Endovascular popliteal artery aneurysm repair (EPAR) is increasingly used over open surgical repair (OPAR). The purpose of this study was to analyze the available literature on their comparative outcomes.
The PubMed and Embase databases were searched to identify studies comparing OPAR and EPAR. Studies with only one treatment and fewer than five patients were excluded. Demographics and outcomes were collected. Bias risk was assessed using a modified version of the Newcastle-Ottawa Scale. Results were computed from random-effects meta-analyses using the DerSimonian-Laird algorithm.
A total of 14 studies were identified encompassing 4880 popliteal artery aneurysm repairs (OPAR, 3915; EPAR, 1210) during the last decade. OPAR patients were younger (standard mean difference, -0.798 [-0.798 to -1.108]; P < .001) and more likely to have worse tibial runoff (odds ratio [OR], 1.949 (1.15-3.31); P = .013) than EPAR patients. OPAR had higher odds of wound complications (OR, 5.182 [2.191-12.256]; P < .001) and lower odds of thrombotic complications (OR, 0.362 [0.155-0.848]; P < .001). OPAR had longer length of stay (standardized mean difference, 2.158 [1.225-3.090]; P < .001) and fewer reinterventions (OR, 0.275 [0.166-0.454]; P < .001). Primary patency was better for OPAR at 1 year and 3 years (relative risk, 0.607 [P = .01] and 0.580 [P = .006], respectively). There was no difference in secondary patency at 1 year and 3 years (0.770 [P = .458] and 0.642 [P = .073], respectively).
EPAR has a lower wound complication rate and shorter length of hospital stay compared with OPAR. This comes at the cost of inferior primary patency but not secondary patency out to 3 years. Studies reporting long-term outcomes are lacking and necessary.
与开放性手术修复（OPAR）相比，血管腔内腘动脉动脉瘤修复术（EPAR）的应用越来越广泛。本研究的目的是分析关于这两种手术比较结果的现有文献。
检索PubMed和Embase数据库，以确定比较OPAR和EPAR的研究。排除仅有一种治疗方法且患者少于5例的研究。收集人口统计学和手术结果数据。使用改良版的纽卡斯尔-渥太华量表评估偏倚风险。采用DerSimonian-Laird算法进行随机效应荟萃分析计算结果。
共纳入14项研究，涵盖过去十年间4880例腘动脉动脉瘤修复术（OPAR 3915例；EPAR 1210例）。与接受EPAR的患者相比，接受OPAR的患者更年轻（标准平均差，-0.798[-0.798至-1.108]；P<.001），胫后血流较差的可能性更大（优势比[OR]，1.949[1.15 - 3.31]；P = .013）。OPAR发生伤口并发症的几率更高（OR，5.182[2.191 - 12.256]；P<.001），发生血栓形成并发症的几率更低（OR，0.362[0.155 - 0.848]；P<.001）。OPAR的住院时间更长（标准化平均差，2.158[1.225 - 3.090]；P<.001），再次干预的次数更少（OR，0.275[0.166 - 0.454]；P<.001）。OPAR在1年和3年时的原发性通畅率更好（相对风险分别为0.607[P = .01]和0.580[P = .006]）。1年和3年时的继发性通畅率无差异（分别为0.770[P = .458]和0.642[P = .073]）。
与OPAR相比，EPAR的伤口并发症发生率更低，住院时间更短。这是以原发性通畅率较低为代价的，但3年内继发性通畅率无差异。缺乏关于长期结果的报道，这是必要的。
