Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
J Vasc Surg. 2024 Dec;80(6):1883-1893.e2. doi: 10.1016/j.jvs.2024.07.084. Epub 2024 Jul 26.
This paired meta-analysis aimed to compare the mortality and morbidity of endovascular revascularization (EVR) and open surgical revascularization (OSR) as the first strategy for arterial acute mesenteric ischemia (AMI).
This systematic review and meta-analysis were performed in accordance with the PRISMA statement. A systematic search strategy was performed to identify eligible studies using the following databases: PubMed, Embase, and Cochrane Library database from inception to December 31, 2023, with restriction to the English language. The end search date was January 2, 2024. The primary outcome was short-term mortality. Secondary outcomes included bowel resection, second-look laparotomy, and short bowel syndrome. The counterenhanced funnel plot and the Peters' test were used to assess bias. Outcomes were reported as odds ratio (OR) with a 95% confidence interval (CI) using the Mantel-Haenszel method. The GRADE classification was used to estimate the certainty of evidence.
A total of 11 studies (1141 patients) comparing EVR vs OSR for arterial AMI were identified and analyzed. The mean patient age was 61.9 to 73.6 years and 45.1% of the patients were male. Compared with OSR, EVR as the first treatment may not decrease short-term mortality (OR, 0.79; 95% CI, 0.50-1.25; P = .31; very low certainty) and second-look laparotomy (OR, 1.00; 95% CI, 0.30-3.36; P = .99; very low certainty). However, EVR may be associated with decreased bowel resection (OR, 0.42; 95% CI, 0.20-0.88; P = .022; very low certainty) and short bowel syndrome (OR, 0.39; 95% CI, 0.21-0.75; P = .005; very low certainty). The metaregression revealed that the mortality regarding EVR vs OSR was not impacted significantly by thrombotic etiology (-0.002; 95% CI, -0.027 to 0.022; P = .85), whereas it was impacted significantly by publication year (0.076; 95% CI, 0.069-0.145; P = .031).
Compared with OSR, EVR as the first treatment for arterial AMI may not decrease short-term mortality or second-look laparotomy. Future multicenter randomized controlled trials are needed urgently to confirm these results.
本配对荟萃分析旨在比较血管内血管重建术（EVR）和开放式血管重建术（OSR）作为急性肠系膜动脉缺血（AMI）的一线治疗策略的死亡率和发病率。
本系统评价和荟萃分析根据 PRISMA 声明进行。使用以下数据库进行了系统搜索策略，以确定符合条件的研究：PubMed、Embase 和 Cochrane Library 数据库，从成立到 2023 年 12 月 31 日，限制使用英语。最终搜索日期为 2024 年 1 月 2 日。主要结局是短期死亡率。次要结局包括肠切除术、二次剖腹探查术和短肠综合征。使用反增强漏斗图和彼得斯检验评估偏倚。使用 Mantel-Haenszel 方法报告优势比（OR）和 95%置信区间（CI）。使用 GRADE 分类来评估证据的确定性。
共确定并分析了 11 项比较 EVR 与 OSR 治疗动脉 AMI 的研究（1141 例患者）。患者平均年龄为 61.9 至 73.6 岁，45.1%为男性。与 OSR 相比，EVR 作为一线治疗可能不会降低短期死亡率（OR，0.79；95%CI，0.50-1.25；P=0.31；非常低的确定性）和二次剖腹探查术（OR，1.00；95%CI，0.30-3.36；P=0.99；非常低的确定性）。然而，EVR 可能与肠切除术减少（OR，0.42；95%CI，0.20-0.88；P=0.022；非常低的确定性）和短肠综合征（OR，0.39；95%CI，0.21-0.75；P=0.005；非常低的确定性）有关。荟萃回归表明，EVR 与 OSR 的死亡率不受血栓形成病因的显著影响（-0.002；95%CI，-0.027 至 0.022；P=0.85），但受发表年份的显著影响（0.076；95%CI，0.069-0.145；P=0.031）。
与 OSR 相比，EVR 作为动脉 AMI 的一线治疗可能不会降低短期死亡率或二次剖腹探查术。需要紧急进行多中心随机对照试验来证实这些结果。
