PDF(Sci-hub)
Abstract：
OBJECTIVE: To summarize the best available evidence comparing open vs endovascular popliteal artery aneurysm (PAA) repair. We also summarized the natural history of PAAs to support of the Society for Vascular Surgery guidelines.
METHODS: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate.
RESULTS: We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30 days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3 years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30 days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. One study showed that at 5 years, approximately one-half of the patients had complications.
CONCLUSIONS: This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.
METHODS: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate.
RESULTS: We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30 days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3 years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30 days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. One study showed that at 5 years, approximately one-half of the patients had complications.
CONCLUSIONS: This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.
摘要：
目的：总结比较开放和腔内修复的最佳证据。我们还总结了PAA的自然史，以支持血管外科学会的指南。
方法：我们搜索了MEDLINE，EMBASE,Cochrane数据库,和Scopus用于研究开放与血管内方法治疗的PAA患者。我们还纳入了未经治疗的患者的自然史研究。研究由成对的独立审稿人进行选择和评估。适当时进行荟萃分析。
结果：我们从2191个候选参考文献中确定了32个原始研究和4个系统综述。Meta分析显示,与血管内途径相比,开放手术修复与1年时较高的原发性通畅性相关(比值比[OR]，2.10；95%置信区间[CI]，1.41-3.12),30天的闭塞率较低(OR，0.41；95%CI，0.24-0.68)和较少的再干预(OR，0.28；95%CI，0.17-0.45），但住院时间较长(标准化平均差，2.16；95%CI，1.23-3.09）和更多的伤口并发症（OR，5.18；95%CI，2.19-12.26）。3年原发通畅率无统计学差异(OR,1.38；95%CI，0.97-1.97），二级通畅性（或，1.59；95%CI，0.84-3.03），最长随访时的死亡率(OR，0.49；95%CI，0.21-1.17），30天死亡率(或，0.28；95%CI，0.06-1.36)，或截肢(发病率比率，0.85；95%CI，0.56-1.31）。这些估计的确定性是，总的来说,低。对PAA自然史的研究表明，血栓栓塞并发症和截肢在平均观察时间为18个月时发生，并且很常见。一项研究表明，5年后，大约一半的患者有并发症.
结论：本系统综述提供了对PAA患者重要的事件发生率。尽管证据的确定性很低,这些比率以及外科专业知识和解剖可行性可以帮助患者和外科医生参与共同决策.
方法：我们搜索了MEDLINE，EMBASE,Cochrane数据库,和Scopus用于研究开放与血管内方法治疗的PAA患者。我们还纳入了未经治疗的患者的自然史研究。研究由成对的独立审稿人进行选择和评估。适当时进行荟萃分析。
结果：我们从2191个候选参考文献中确定了32个原始研究和4个系统综述。Meta分析显示,与血管内途径相比,开放手术修复与1年时较高的原发性通畅性相关(比值比[OR]，2.10；95%置信区间[CI]，1.41-3.12),30天的闭塞率较低(OR，0.41；95%CI，0.24-0.68)和较少的再干预(OR，0.28；95%CI，0.17-0.45），但住院时间较长(标准化平均差，2.16；95%CI，1.23-3.09）和更多的伤口并发症（OR，5.18；95%CI，2.19-12.26）。3年原发通畅率无统计学差异(OR,1.38；95%CI，0.97-1.97），二级通畅性（或，1.59；95%CI，0.84-3.03），最长随访时的死亡率(OR，0.49；95%CI，0.21-1.17），30天死亡率(或，0.28；95%CI，0.06-1.36)，或截肢(发病率比率，0.85；95%CI，0.56-1.31）。这些估计的确定性是，总的来说,低。对PAA自然史的研究表明，血栓栓塞并发症和截肢在平均观察时间为18个月时发生，并且很常见。一项研究表明，5年后，大约一半的患者有并发症.
结论：本系统综述提供了对PAA患者重要的事件发生率。尽管证据的确定性很低,这些比率以及外科专业知识和解剖可行性可以帮助患者和外科医生参与共同决策.
