Benfor Bright, Sinha Kavya, Lumsden Alan B, Roy Trisha L
Department of Vascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
J Vasc Surg Cases Innov Tech. 2023 May 3;9(2):101185. doi: 10.1016/j.jvscit.2023.101185. eCollection 2023 Jun.
We evaluated how contemporary data on infrapopliteal vessel preparation have been reported to identify knowledge gaps and opportunities for future research.
A literature search was performed on Web of Science, PubMed, and Google Scholar to identify clinical research studies reporting on the outcomes of vessel preparation in below-the-knee lesions between 2006 and 2021. Studies were excluded if they were case reports or case series with a sample size of <10.
A total of 15 studies comprising 5450 patients were included in this review, with vessel preparation performed in 2179 cases (40%). Of the 15 studies, 2 were randomized controlled trials, 6 were prospective cohort studies, and 7 were retrospective studies. Only 2 of the 15 studies evaluated intravascular lithotripsy devices, and 6 were noncomparative studies. The mean diameter stenosis treated was 86.7% ± 12.6%, and the lesion length was 71.7 ± 55.3 mm. Large heterogeneity was found in the choice and definitions of end points and lesion characterization. Procedural success ranged between 84% and 90%, and bailout stenting was performed in 0.8% to 15% of cases. Of the five studies comparing procedural success of atherectomy with or without balloon angioplasty to balloon angioplasty alone, only one was in favor of the former (99% vs 90%; < .001). The remaining studies did not show any statistically significant differences. Similarly, atherectomy had a significantly superior limb salvage rate in only one of seven studies (91% vs 73%; = .036). In contrast, the seven studies evaluating target lesion revascularization reported conflicting outcomes, with two in favor of atherectomy, two against atherectomy, and three reporting similar outcomes between atherectomy and balloon angioplasty alone. None of the studies evaluating intravascular lithotripsy was comparative.
The current body of evidence on vessel preparation in tibial arteries is largely based on observational studies with a large amount of heterogeneity and a number of inconsistencies. Further clinical and experimental studies with more robust study designs are warranted to investigate the comparative efficacy and safety of vessel preparation in calcified tibial arteries.
我们评估了有关腘下血管准备的当代数据是如何报告的，以识别知识空白和未来研究的机会。
在科学网、PubMed和谷歌学术上进行文献检索，以识别2006年至2021年间报告膝下病变血管准备结果的临床研究。如果研究为病例报告或样本量小于10的病例系列，则将其排除。
本综述共纳入15项研究，涉及5450例患者，其中2179例（40%）进行了血管准备。在这15项研究中，2项为随机对照试验，6项为前瞻性队列研究，7项为回顾性研究。15项研究中只有2项评估了血管内碎石术装置，6项为非对比研究。治疗的平均直径狭窄率为86.7%±12.6%，病变长度为71.7±55.3mm。在终点的选择和定义以及病变特征方面发现了很大的异质性。手术成功率在84%至90%之间，0.8%至15%的病例进行了补救性支架置入术。在五项比较旋切术联合或不联合球囊血管成形术与单纯球囊血管成形术手术成功率的研究中，只有一项支持前者（99%对90%；P<.001）。其余研究未显示任何统计学上的显著差异。同样，在七项研究中只有一项显示旋切术的肢体挽救率显著更高（91%对73%；P=.036）。相比之下，七项评估靶病变血管重建的研究报告了相互矛盾的结果，两项支持旋切术，两项反对旋切术，三项报告旋切术与单纯球囊血管成形术的结果相似。评估血管内碎石术的研究均无对比性。
目前关于胫动脉血管准备的证据主要基于观察性研究，存在大量异质性和一些不一致之处。需要进一步开展设计更严谨的临床和实验研究，以探讨钙化胫动脉血管准备的比较疗效和安全性。
