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经皮深静脉动脉化治疗无其他选择的严重肢体缺血的短期结局和疗效:一项系统评价和荟萃分析

Short-Term Outcomes and Efficacy of Percutaneous Deep Vein Arterialization for No-Option Critical Limb Ischemia: A Systematic Review and Meta-Analysis.

作者信息

Roustazadeh Roshanak, Gombert Alexander, Krabbe Julia, Jacobs Michael, Doukas Panagiotis

机构信息

European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany.

Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.

出版信息

Biomedicines. 2024 Jan 30;12(2):318. doi: 10.3390/biomedicines12020318.

Abstract

BACKGROUND

Percutaneous deep vein arterialization (pDVA) is considered a treatment modality in patients with no-option critical limb ischemia. However, there is still a paucity of evidence regarding its safety and efficacy.

DATA SOURCES

MEDLINE (via PubMed), Embase and Web of Science databases as well as the CENTRAL registry up to the end of June 2023.

METHODS

This review adhered to the PRISMA guidelines (PROSPERO registration no. CRD42023445171). The risk of bias was assessed using the methodological index for non-randomized studies (MINORS). Primary endpoints included technical success, overall survival and limb salvage during the follow-up. Amputation-free survival at 30 days, 6 months and 1 year as well as complete wound healing, major adverse limb events and reintervention were investigated as secondary outcomes.

RESULTS

Five observational studies, comprising 208 patients (142 Rutherford class 5/77 Rutherford class 6), were included. MINORS revealed a low risk of bias. The meta-analysis reached a pooled technical success rate of 96.2% (95% CI: 91.5-98.4), an overall survival of 82.8% (95% CI: 70.5-95.2) and a limb salvage rate of 77.2% (95% CI: 65.2-89.1) during the follow-up. The amputation-free survival at 30 days, 6 months and 1 year was 87.8%, 68.7% and 65.6%, respectively. Furthermore, pDVA resulted in a complete wound healing rate of 53.4% (95% CI: 30.3-76.5). The pooled reintervention rate was as high as 46.7% (37.1-56.3%).

CONCLUSIONS

PDVA seems a feasible bail-out strategy for patients with no option for routine treatment of CLTI. However, due to the small number of studies, the strength of the evidence is low.

摘要

背景

经皮深静脉动脉化(pDVA)被认为是治疗无可选择的严重肢体缺血患者的一种治疗方式。然而,关于其安全性和有效性的证据仍然匮乏。

数据来源

截至2023年6月底的MEDLINE(通过PubMed)、Embase和Web of Science数据库以及CENTRAL注册库。

方法

本综述遵循PRISMA指南(PROSPERO注册号:CRD42023445171)。使用非随机研究的方法学指标(MINORS)评估偏倚风险。主要终点包括随访期间的技术成功率、总生存率和肢体挽救率。将30天、6个月和1年时的无截肢生存率以及完全伤口愈合、主要肢体不良事件和再次干预作为次要结局进行研究。

结果

纳入了5项观察性研究,共208例患者(142例Rutherford 5级/77例Rutherford 6级)。MINORS显示偏倚风险较低。荟萃分析得出随访期间的综合技术成功率为96.2%(95%CI:91.5 - 98.4),总生存率为82.8%(95%CI:70.5 - 95.2),肢体挽救率为77.2%(95%CI:65.2 - 89.1)。30天、6个月和1年时的无截肢生存率分别为87.8%、68.7%和65.6%。此外,pDVA导致的完全伤口愈合率为53.4%(95%CI:30.3 - 76.5)。综合再次干预率高达46.7%(37.1 - 56.3%)。

结论

对于无可选择进行常规治疗的CLTI患者,pDVA似乎是一种可行的挽救策略。然而,由于研究数量较少,证据强度较低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1fa/10886738/0e66706bbd9a/biomedicines-12-00318-g001.jpg

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