急性肢体缺血的血管内治疗与手术治疗：一项对临床试验的系统评价和荟萃分析
Endovascular versus surgical treatment for acute limb ischemia: a systematic review and meta-analysis of clinical trials.
作者信息
Enezate Tariq H, Omran Jad, Mahmud Ehtisham, Patel Mitul, Abu-Fadel Mazen S, White Christopher J, Al-Dadah Ashraf S
机构信息
Cardiovascular Medicine Department, University of Missouri- Columbia School of Medicine, Columbia, Missouri, USA.
Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California, USA.
出版信息
Cardiovasc Diagn Ther. 2017 Jun;7(3):264-271. doi: 10.21037/cdt.2017.03.03.
BACKGROUND
A number of small studies have suggested that outcomes following endovascular (ENDO) therapy are comparable to those following surgical (SURG) revascularization for patients presenting with acute limb ischemia (ALI). We sought to compare mortality, limb amputation and recurrent ischemia across both revascularization strategies.
METHODS
A comprehensive database search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases from January 1990 through January 2016 was performed to identify studies of ENDO versus SURG for ALI. Two independent reviewers selected studies and extracted the data. Random-effects meta-analysis was used to pool results across studies. Heterogeneity of treatment effect among trials was assessed using the I statistics. The primary endpoints were mortality and limb amputation at 1 month, 6 and 12 months. Secondary endpoint was recurrent ischemia at one year.
RESULTS
A total of 1,773 patients were included from six studies (five randomized prospective and one observational retrospective) comparing ENDO and SURG in the setting of ALI. The mean age was 67 years and 65% of patients were male. There were no differences in mortality between the two groups at 1 month [risk ratio (RR) for ENDO vs. SURG is 0.70; 95% confidence interval (CI), 0.33 to 1.50], 6 months (RR 1.12; CI, 0.78 to 1.61) or 12 months (RR 0.74; CI, 0.29 to 1.85). Similarly, there was no significant difference in amputation rates between ENDO and SURG at 1 month (RR 0.75; CI, 0.40 to 1.42), 6 months (RR 0.87; CI, 0.52 to 1.48) or 12 months (RR 0.81; CI, 0.55 to 1.18). When looking into secondary outcomes, recurrent ischemia was not different between the two groups (RR 1.12; CI, 0.75 to 1.67).
CONCLUSIONS
In patients presenting with ALI (<2 weeks of duration), ENDO and SURG approaches have similar rates of short-term and 12 month mortality, limb amputation and recurrent ischemia.
背景
多项小型研究表明，对于急性肢体缺血（ALI）患者，血管内（ENDO）治疗后的结果与外科（SURG）血管重建术后的结果相当。我们试图比较两种血管重建策略的死亡率、肢体截肢率和复发性缺血情况。
方法
对1990年1月至2016年1月期间的MEDLINE、EMBASE和Cochrane对照试验中央注册库（CENTRAL）电子数据库进行全面检索，以确定关于ALI的ENDO与SURG对比研究。两名独立的评审员筛选研究并提取数据。采用随机效应荟萃分析汇总各项研究结果。使用I统计量评估各试验间治疗效果的异质性。主要终点为1个月、6个月和12个月时的死亡率和肢体截肢率。次要终点为1年时的复发性缺血。
结果
六项研究（五项随机前瞻性研究和一项观察性回顾性研究）纳入了共1773例在ALI情况下对比ENDO和SURG的患者。平均年龄为67岁，65%的患者为男性。两组在1个月时的死亡率无差异[ENDO与SURG的风险比（RR）为0.70；95%置信区间（CI），0.33至1.50]，6个月时（RR 1.12；CI，0.78至1.61）或12个月时（RR 0.74；CI，0.29至1.85）。同样，ENDO和SURG在1个月时的截肢率（RR 0.75；CI，0.40至1.42）、6个月时（RR 0.87；CI，0.52至1.48）或12个月时（RR 0.81；CI，0.55至1.18）也无显著差异。在观察次要结局时，两组的复发性缺血情况无差异（RR 1.12；CI，0.75至1.67）。
结论
对于病程小于2周的ALI患者，ENDO和SURG方法在短期和12个月死亡率、肢体截肢率和复发性缺血方面的发生率相似。
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