Wilasrusmee Chumpon, Siribumrungwong Boonying, Horsirimanont Suthas, Poprom Napaphat, Jirasiritham Jakrapan, Thakkinstian Ammarin
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand.
Ann Med Surg (Lond). 2017 Jan 25;15:26-33. doi: 10.1016/j.amsu.2017.01.018. eCollection 2017 Mar.
Biologic prosthesis (BP) has been reported as a safe alternative to polytetrafluoroethylene (PTFE) in vascular reconstruction. However, efficacy of BP remains controversial. We, therefore, conducted a systematic review to summarize previous available evidences comparing the BP and PTFE in terms of clinical outcomes.
A literature search of the MEDLINE and Scopus was performed to identify comparative studies reporting outcomes of BP, PTFE, and/or autologous veins graft (VG) in vascular access for hemodialysis or femoropopliteal bypass. The outcome of interest was graft patency. Two reviewers independently extracted data. Meta-analysis with a random-effect model was applied to pool a risk ratio (RR) across studies.
Among 584 articles identified, 11 studies (4 randomized controlled trials (RCT) and 7 cohorts) comprising 2627 patients were eligible for pooling. Seven studies compared BP with PTFE and 3 studies compared PTFE with VG. Among BP vs PTFE, pooling based on 3 RCTs yielded the pooled RR of 1.54 (95% CI: 1.10, 2.16), indicating 54% higher graft patency in VG than PTFE. Adding the 7 cohorts in this pooling yield similar results with the pooled RR of 1.29 (95% CI: 1.15, 1.45). The pooled RR of graft patency for BP vs VG was 0.74 (95% CI, 0.55, 1.00), indicating 26% lower graft patency in BP than VG.
Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency. An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit.
生物假体（BP）已被报道为血管重建中聚四氟乙烯（PTFE）的一种安全替代物。然而，BP的疗效仍存在争议。因此，我们进行了一项系统评价，以总结先前比较BP和PTFE临床结局的现有证据。
检索MEDLINE和Scopus数据库，以识别报告BP、PTFE和/或自体静脉移植物（VG）在血液透析血管通路或股腘动脉旁路移植术中结局的比较研究。感兴趣的结局是移植物通畅率。两名研究者独立提取数据。采用随机效应模型进行荟萃分析，以汇总各研究的风险比（RR）。
在识别出的584篇文章中，11项研究（4项随机对照试验（RCT）和7项队列研究）共2627例患者符合纳入荟萃分析的标准。7项研究比较了BP与PTFE，3项研究比较了PTFE与VG。在BP与PTFE的比较中，基于3项RCT的荟萃分析得出汇总RR为1.54（95%CI：1.10，2.16），表明VG的移植物通畅率比PTFE高54%。将7项队列研究纳入该荟萃分析得到了相似的结果，汇总RR为1.29（95%CI：1.15，1.45）。BP与VG的移植物通畅率汇总RR为0.74（95%CI，0.55，1.00），表明BP的移植物通畅率比VG低26%。
我们的首次荟萃分析表明，生物合成假体可能通过提高移植物通畅率而优于PTFE。需要进行更新的荟萃分析或大规模随机对照试验来证实这一益处。
