内膜下血管成形术治疗下肢动脉慢性闭塞性病变的荟萃分析  

Subintimal angioplasty for chronic arterial occlusive disease： a systematic review

作　　者：李祥祥[1] 陆信武[1] 叶开创[1] 蒋米尔[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科上海交通大学血管病诊治中心,200011

出　　处：《中华医学杂志》2012年第21期1486-1491,共6页National Medical Journal of China

摘　　要：目的 评价内膜下血管成形术（SIA）治疗下肢动脉慢性闭塞性病变的临床效果。方法 计算机检索和人工检索所有SIA治疗下肢动脉慢性闭塞性病变的相关文献。根据纳入和排除标准，3位作者独立完成相关文献的质量评估和数据提取。研究终点包括技术成功率、一期通畅率、保肢率及并发症的发生率。结果 共检索352篇相关文献，14篇文献（2350例患者）符合纳入标准。根据术中是否选择性使用重返真腔导管，技术成功率分别为96．4％和87％（P〈0．01）。术后6、12个月保肢率分别为90．5％和81．5％。根据术前有无使用抗血小板药治疗，术后6个月的一期通畅率分别为91％和68．5％（P〈0．01）。并发症的平均发生率为8．25％，罕有严重并发症的发生。结论 SIA治疗下肢动脉慢性闭塞性病变安全有效，具有较高的技术成功率和保肢率，罕有严重并发症的发生。选择性使用重返真腔设备和术前使用抗血小板药物可以提高技术成功率和一期通畅率。但鉴于目前缺少大宗数据的随机对照研究以及长期随访结果，还有待于更多高质量的研究结果来证实。Objective To evaluate the clinical effectiveness of subintimal angioplasty in treating chronic arterial occlusive disease of lower extremity. Methods Eligible studies concerning treatment by subintimal angioplasty in patients with arterial occlusive disease of lower extremity were identified from electronic database, cross-reference search and relative articles. The study quality and data extraction of all relevant articles were assessed by three independent reviewers. The study endpoints were technical success, primary pateney, limb salvage, and complications. Results A total of 352 studies were selected for comprehensive review. Fourteen studies including a total of 2350 patients matched the selection criteria. According to whether selective using of re-entery catheter were used or not, the technical success rates were 96. 4% and 87% （P 〈0. 01 ）. Limb salvage rate was 90. 5% and 81.5% at 6 and 12 months respectively. Depending on whether preoperative use of anti-platelet drug , primary patency rate was 91% and 68.5% at 6 months respectively （P 〈 0.01 ）. The complication rate was 8.25% without serious complications. Conclusion This Meta-analysis suggests that subintimal angioplasty is a safe and effective method in treating chronic arterial occlusive disease of lower extremity with high technical success rate and limb salvage, and low serious complications. Selective using of re-entry devices and preoperative anti-platelet drug can improve the technical success rate and primary patency rate significantly. Despite the high rate of technical and clinical success of the procedure, randomized contrast trials and long-term follow-up results are required to confirm the efficacy of these results.

关 键 词：内膜下血管成形术 腔内再管化术 下肢动脉 慢性闭塞性疾病 荟萃分析 

分 类 号：R543.5[医药卫生—心血管疾病]