摘要
背景与目的:严重肢体缺血(CLI)是下肢动脉疾病的终末阶段,其中膝下动脉病变因其复杂的解剖结构和病理特点,治疗难度较大,患者面临较高的截肢率和病死率。近年来,血管内治疗技术不断发展,然而关于不同治疗策略的优劣仍存争议。为系统比较不同治疗方法的疗效,本研究采用网络Meta分析方法,综合评价普通球囊扩张术(BA)、裸金属支架(BMS)、药物涂层球囊(DCB)、药物洗脱支架(DES)及轨道旋切术(OA)在治疗CLI合并膝下动脉病变中的效果,为临床制定优化的血管内治疗方案提供循证依据。方法:系统检索多个医学数据库,最终纳入17项随机对照试验,共计2379例患者,开展网络Meta分析。主要结局指标包括术后1年的一期通畅率、靶病变再次血运重建(TLR)率及大截肢率。结果:在术后1年一期通畅率方面,DCB显示出最优效果,明显优于DES(OR=4.55,95%CI=1.14~20.00)、BMS(OR=15.77,95%CI=3.50~71.00)和BA(OR=9.02,95%CI=2.43~33.47)。在术后1年TLR率方面,DCB同样最具优势,明显低于BA(OR=0.40,95%CI=0.22~0.72)。术后1年大截肢率方面,各治疗方法之间差异无统计学意义,但累积排序结果显示DES在降低大截肢率方面可能更具优势。结论:DCB在提高一期通畅率和降低TLR率方面具有明显优势,DES则可能是降低大截肢风险的最有效手段。建议在治疗CLI合并膝下动脉病变时优先考虑DCB和DES。
Background and Aims:Critical limb ischemia(CLI)represents the end stage of lower extremity arterial disease.Infrapopliteal artery lesions,due to their complex anatomical and pathological characteristics,pose significant therapeutic challenges,with patients facing high rates of amputation and mortality.In recent years,endovascular treatment techniques have evolved rapidly;however,controversy remains regarding the optimal treatment strategy.To systematically compare the efficacy of different treatment modalities,this study conducted a network Meta-analysis to comprehensively evaluate balloon angioplasty(BA),bare-metal stents(BMS),drug-coated balloons(DCB),drug-eluting stents(DES),and orbital atherectomy(OA)in the treatment of CLI involving infrapopliteal artery lesions,providing evidence to guide clinical decision-making on optimal endovascular therapy.Methods:A comprehensive search of multiple medical databases was performed,and 17 randomized controlled trials with a total of 2379 patients were included.A network Meta-analysis was conducted.The primary outcomes were 1-year primary patency rate,target lesion revascularization(TLR)rate,and major amputation rate.Results:DCB showed the highest efficacy in 1-year primary patency,significantly outperforming DES(OR=4.55,95%CI=1.14-20.00),BMS(OR=15.77,95%CI=3.50-71.00),and BA(OR=9.02,95%CI=2.43-33.47).DCB also demonstrated the lowest 1-year TLR rate,significantly lower than BA(OR=0.40,95%CI=0.22-0.72).There were no statistically significant differences among treatment methods in terms of the 1-year major amputation rate;however,the cumulative ranking analysis suggested that DES may be the most effective in reducing major amputation risk.Conclusion:DCB offers clear advantages in improving primary patency and reducing TLR rates,while DES may be the most effective strategy for reducing the risk of major amputation.DCB and DES should be prioritized in the endovascular treatment of CLI involving infrapopliteal artery lesions.
作者
周阳
舒畅
ZHOU Yang;SHU Chang(Department of Vascular Surgery,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Institute of Vascular Diseases,Central South University,Changsha 410011,China;Center of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)
出处
《中国普通外科杂志》
北大核心
2025年第6期1149-1156,共8页
China Journal of General Surgery
基金
湖南省长沙市科技计划重大专项基金资助项目(kh2205016)。
关键词
外周动脉疾病
慢性肢体威胁性缺血
膝下动脉
META分析
Peripheral Arterial Disease
Chronic Limb-Threatening Ischemia
Infrapopliteal Artery
Meta-Analysis
