Viabahn覆膜支架与旁路途径治疗下肢动脉硬化闭塞症有效性的系统评价及Meta分析  

Viabahn covered-stent and bypass approach for the treatment of lower extremity arteriosclerosis obliterans:a systematic review and meta-analysis of its effectiveness

作　　者：林印胜 陈梅 郭坚东 伍思意 张艳[1] 李承志[1] LIN Yinsheng;CHEN Mei;GUO Jiandong;WU Siyi;ZHANG Yan;LI Chengzhi(Department of Interventional Radiology and Vascular Surgery,First Affiliated Hospital of Jinan University,Guangzhou,Guangdong Province 510630,China)

机构地区：[1]暨南大学附属第一医院介入血管外科,广东广州510630

出　　处：《介入放射学杂志》2023年第8期774-781,共8页Journal of Interventional Radiology

摘　　要：目的系统评价Viabahn覆膜支架与以人工血管为移植物的旁路途径治疗下肢动脉硬化闭塞症的有效性,并且探讨不同直径的Viabahn覆膜支架对股浅动脉通畅率的影响。方法检索数据库包括万方数据知识平台、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、EmBase、Cochrane Library和PubMed上有关肝素涂层覆膜支架治疗下肢动脉硬化闭塞症的临床研究。文献检索时间及语言无限制,文献筛选、质量评估、数据提取至少由2位研究者独立完成并交叉核对,采用Cochrane软件和RevMan 5.3软件完成结果分析。结果纳入文献共10篇(对照研究7篇、非对照研究3篇),肝素涂层覆膜支架与旁路途径疗效对比研究7篇,不同肝素涂层覆膜支架直径疗效对比研究5篇。肝素涂层支架组(Viabahn组)患者792例,旁路途经组(Bypass组)患者299例,Viabahn组行不同支架直径亚组分析(a组:5 mm、b组:6 mm、c组:7 mm),a、b、c组分别有61例、474例、84例患者。Bypass组不仅一期通畅率优于Viabahn组[OR 0.47(0.23,0.94),P=0.03],而且技术成功率更高[RR 0.97(0.94,1.00),P=0.02],但是Bypass组的住院时间明显长于Viabahn组[MD-4.89(-5.29,-4.48),P<0.00001],两组在截肢率及二期通畅率上没有统计学差异(P>0.05)。a组与b组通畅率没有统计学差异[OR 0.63(0.31,1.28),P=0.20],c组的通畅率要优于b组[(OR 0.57(0.33,0.98),P=0.04]。结论与Viabahn相比,以人工血管作为移植物的旁路途经具有更好的一期通畅率及技术成功率,但是需要更长的住院时间;推荐置入7 mm直径的Viabahn会得到更高的通畅率,但是需要根据患者实际血管直径来选择。Objective To systematically evaluate the effectiveness of the Viabahn covered-stent and the bypass approach by using artificial blood vessel as graft in the treatment of lower extremity arteriosclerosis obliterans(ASO),and to discuss the effect of different diameters of the Viabahn covered-stent on the patency rate of the superficial femoral artery.Methods Computerized retrieval of academic papers concerning the clinical study of heparin-coated covered-stent for lower extremity AOS from the databases of Wanfang Data Knowledge Platform,China Journal Full-text Database(CNKI),China Biomedical Literature Database(CBM),EmBase,Cochrane Library,and PubMed was conducted.Both of the published time and language of the papers are unrestricted.At least two researchers independently completed the literature screening,quality assessment and data extraction,and the results were cross-checked.Cochrane software RevMan 5.3 was used to complete the analysis of results.Results A total of 10 papers,including 7 randomized controlled trials(RCT)and 3 non-control studies,were enrlled in this study.There were 7 RCTs on the efficacy of heparincoated covered-stent and bypass approach,and 3 comparative studies on the therapeutic effect of different diameter heparin-coated coated stents.There were 792 patients in the heparin-coated stent group(Viabahn group)and 299 patients in the bypass group(Bypass group).According to the used stent diameter,the Viabahn group was further divided into subgroup a(5 mm,n=61),subgroup b(6 mm,n=474),and subgroup c(7 mm,n=84).The primary patency rate in the Bypass group was better than that in the Viabahn group(OR:0.47(0.23,0.94),P=0.03),and the technical success rate in the Bypass group was remarkably higher than that in the Viabahn group(RR:0.97(0.94,1.00),P=0.02),although the hospital stay in the Bypass group was obviously longer than that in the Viabahn group(MD:-4.89(-5.29,-4.48),P<0.00001).There were no statistically significant differences in the amputation rate and the secondary patency rate between the

关 键 词：下肢动脉硬化闭塞症 肝素涂层覆膜支架 旁路途径 有效性 META分析 

分 类 号：R543.5[医药卫生—心血管疾病]