Martin Guy, Covani Marco, Saab Fadi, Mustapha Jihad, Malina Martin, Patrone Lorenzo
West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Faculty of Medicine, University of Messina, Messina, Italy.
J Vasc Surg. 2021 Oct;74(4):1394-1405.e4. doi: 10.1016/j.jvs.2021.04.050. Epub 2021 May 19.
The endovascular treatment of femoropopliteal lesions is an integral part of managing peripheral arterial disease. The antegrade approach is the most widely used technique with good evidence for its safety and efficacy. However, crossing a lesion, particularly chronic total occlusions (CTO), can be technically challenging and so the retrograde approach is increasingly used to maximize the chances of procedural success. The objective of this systematic review was, therefore, to assess the safety and effectiveness of the ipsilateral retrograde approach to femoropopliteal lesions.
A systematic review conforming to the PRISMA standards was undertaken. MEDLINE, EMBASE, and The Cochrane Register were searched between January 1, 1988, and January 1, 2020. Full-text, English-language, peer-reviewed articles pertaining to peripheral arterial disease, endovascular intervention and access site were included.
A total of 8599 articles were screened, of which 38, involving 1940 patients undergoing 2184 retrograde procedures, were included. The mean number of patients per study was 51.1, with three studies including fewer than 10 and four more than 100 patients. The reported follow-up ranged from 30 days to 3 years, and six articles did not report any long-term outcome data. A retrograde approach was used as the primary access route in 45.% of procedures (648/1438) with relevant data. Primary technical success was achieved in 88% (1920/2184; 64%-100%) with a reported complication rate of 11% (235/2117; 0%-27%). Overall, the quality of evidence was poor, with just seven articles deemed to be of high quality with a low risk of bias. A meta-analysis was not deemed appropriate owing to heterogeneity of data.
An ipsilateral retrograde approach to femoropopliteal lesions has good primary technical success and a low rate of complications. It has a promising role as a bailout, or even a primary access technique, in complex lesions. Patient positioning, puncture site and technique, lesion anatomy, and the size of catheters and devices used are important considerations to achieve the best outcomes. There remains a paucity of robust evidence for its superiority over traditional antegrade approaches, and further work is required to identify the optimal technique and those patients who would benefit most from the approach.
股腘动脉病变的血管内治疗是外周动脉疾病管理的重要组成部分。顺行入路是应用最广泛的技术，其安全性和有效性有充分证据。然而，穿过病变，尤其是慢性完全闭塞（CTO）病变，在技术上可能具有挑战性，因此逆行入路越来越多地被用于最大限度地提高手术成功率。因此，本系统评价的目的是评估股腘动脉病变同侧逆行入路的安全性和有效性。
进行了一项符合PRISMA标准的系统评价。检索了1988年1月1日至2020年1月1日期间的MEDLINE、EMBASE和Cochrane注册库。纳入了与外周动脉疾病、血管内介入和穿刺部位相关的全文、英文、经同行评审的文章。
共筛选出8599篇文章，其中38篇被纳入，涉及1940例患者接受2184例逆行手术。每项研究的平均患者数为51.1例，3项研究的患者数少于10例，4项研究的患者数多于100例。报道的随访时间从30天到3年不等，6篇文章未报告任何长期结局数据。在45.%（648/1438）有相关数据的手术中，逆行入路被用作主要入路途径。初次技术成功率为88%（1920/2184；64%-100%），报道的并发症发生率为11%（235/2117；0%-27%）。总体而言，证据质量较差，只有7篇文章被认为质量高且偏倚风险低。由于数据的异质性，不适合进行荟萃分析。
股腘动脉病变同侧逆行入路具有良好的初次技术成功率和较低的并发症发生率。在复杂病变中，它作为补救措施甚至主要入路技术具有广阔的应用前景。患者体位、穿刺部位和技术、病变解剖结构以及所用导管和器械的尺寸是获得最佳结果的重要考虑因素。与传统顺行入路相比，其优越性的有力证据仍然不足，需要进一步开展工作以确定最佳技术以及最能从该入路中获益的患者。
