D'cruz Reuban Toby, Leong Sze Wai, Syn Nicholas, Tiwari Alok, Sannasi Vikram Vijayan, Singh Sidhu Harvinder Raj, Tang Tjun Yip
1 Department of Surgery, Ng Teng Fong General Hospital, Singapore.
2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Vasc Access. 2019 Jul;20(4):345-355. doi: 10.1177/1129729818814466. Epub 2018 Dec 3.
The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis.
A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a random-effects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed.
Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30-0.31, relative risk = 0.34-0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07-0.26; p < 0.01).
This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates.
本研究旨在评估当前关于在用于血液透析的头臂动静脉内瘘功能衰竭情况下，头臂弓狭窄的血管内治疗选择及其疗效的文献。
按照PRISMA指南，于2000年1月至2017年12月期间使用PubMed、Embase和谷歌学术对文献进行系统检索，以研究头臂弓狭窄血管内治疗的疗效。提取以英文发表的随机对照试验和观察性研究的数据，采用随机效应荟萃分析确定主要通畅率和次要通畅率的合并比例。对头臂覆膜支架、裸金属支架和经皮腔内血管成形术的疗效进行亚组分析。
在总共125项研究中，经共识纳入11项进行分析。总体而言，对457例患者治疗后6个月和12个月的主要和次要通畅率进行了回顾和分析。与接受裸金属支架或经皮腔内血管成形术的患者相比，头臂覆膜支架组在6个月和12个月时的主要通畅率均显著更高（相对危险度分别为0.30 - 0.31和0.34 - 0.59；p < 0.01）。在12个月时，裸金属支架组的次要通畅率高于经皮腔内血管成形术组（相对危险度 = 0.17，95%置信区间 = o.07 - 0.26；p < 0.01）。
本研究表明，与裸金属支架或经皮腔内血管成形术相比，在头臂弓狭窄中使用头臂覆膜支架具有显著优势，其主要和次要通畅率更高。
