Abstract：
OBJECTIVE: Both bypass surgery and endovascular treatment are well-recognized interventions for the treatment of peripheral artery disease; however, the effect of failed endovascular treatment on subsequent surgeries remains controversial. A systematic review was conducted to compare the outcomes of primary bypass and bypass surgery after endovascular treatment.
METHODS: Three academic databases (Embase, PubMed, and Scopus) were searched from their inception to August 2022. Two independent investigators searched for studies that reported the outcomes of primary bypass surgery and bypass surgery after endovascular treatment in patients with peripheral artery disease. Abstracts and full-text studies were screened independently using duplicate data abstraction. Dichotomous outcome measures were reported using a random-effects model to generate a summary odds ratio (OR) and 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Seventeen retrospective observational studies were selected from 3911 articles and included 8064 patients, 6252 of whom underwent primary bypass surgery and 1812 underwent bypass surgery after endovascular treatment. The mean age was 69.0 years and 61.2% (n = 4938) were male. For perioperative outcomes, the 30-day results showed no difference in mortality (OR, 0.76; 95% CI, 0.53-1.10), or amputation (OR, 0.89; 95% CI, 0.67-1.20). For short- to mid-term outcomes, primary patency did not differ at 6 months (OR, 0.98; 95% CI, 0.81-1.19), 1 year (OR, 1.12; 95% CI, 0.97-1.30), or 2 years (OR, 1.17; 95% CI, 0.85-1.61) follow-up. Amputation-free survival did not differ at 6 months (OR, 1.03; 95% CI, 0.82-1.30), 1 year (OR, 1.09; 95% CI, 0.89-1.32), 2 years (OR, 1.18; 95% CI, 0.93-1.50), or 3 years (OR, 1.09; 95% CI, 0.84-1.40) of follow-up. No significant difference was found in overall survival or second patency.
CONCLUSIONS: This meta-analysis of retrospective, nonrandomized, observational studies suggests that prior endovascular treatment of lower extremity arterial disease does not result in worse perioperative, short-term, or mid-term clinical outcomes of subsequent infrainguinal bypass surgery compared with patients without prior endovascular treatment.
METHODS: Three academic databases (Embase, PubMed, and Scopus) were searched from their inception to August 2022. Two independent investigators searched for studies that reported the outcomes of primary bypass surgery and bypass surgery after endovascular treatment in patients with peripheral artery disease. Abstracts and full-text studies were screened independently using duplicate data abstraction. Dichotomous outcome measures were reported using a random-effects model to generate a summary odds ratio (OR) and 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Seventeen retrospective observational studies were selected from 3911 articles and included 8064 patients, 6252 of whom underwent primary bypass surgery and 1812 underwent bypass surgery after endovascular treatment. The mean age was 69.0 years and 61.2% (n = 4938) were male. For perioperative outcomes, the 30-day results showed no difference in mortality (OR, 0.76; 95% CI, 0.53-1.10), or amputation (OR, 0.89; 95% CI, 0.67-1.20). For short- to mid-term outcomes, primary patency did not differ at 6 months (OR, 0.98; 95% CI, 0.81-1.19), 1 year (OR, 1.12; 95% CI, 0.97-1.30), or 2 years (OR, 1.17; 95% CI, 0.85-1.61) follow-up. Amputation-free survival did not differ at 6 months (OR, 1.03; 95% CI, 0.82-1.30), 1 year (OR, 1.09; 95% CI, 0.89-1.32), 2 years (OR, 1.18; 95% CI, 0.93-1.50), or 3 years (OR, 1.09; 95% CI, 0.84-1.40) of follow-up. No significant difference was found in overall survival or second patency.
CONCLUSIONS: This meta-analysis of retrospective, nonrandomized, observational studies suggests that prior endovascular treatment of lower extremity arterial disease does not result in worse perioperative, short-term, or mid-term clinical outcomes of subsequent infrainguinal bypass surgery compared with patients without prior endovascular treatment.
摘要：
目的：搭桥手术和血管内治疗都是治疗外周动脉疾病的公认干预措施；然而，血管内治疗失败对后续手术的影响仍存在争议.进行了系统评价，以比较血管内治疗后的初次搭桥和搭桥手术的结果。
方法：三个学术数据库(Embase，PubMed,和Scopus）从成立之初到2022年8月进行了搜索。两名独立研究人员搜索了报告外周动脉疾病患者的初次搭桥手术和血管内治疗后搭桥手术结果的研究。使用重复数据抽象独立筛选摘要和全文研究。使用随机效应模型报告二分结果测量，以生成汇总比值比（OR）和95％置信区间（CI）。使用纽卡斯尔-渥太华量表评估偏倚风险。
结果：从3911篇文献中选择了17项回顾性观察性研究，包括8064例患者，其中6252人接受了初次搭桥手术，1812人接受了血管内治疗后的搭桥手术。平均年龄为69.0岁，男性占61.2％（n=4938）。对于围手术期结果，30天的结果显示死亡率没有差异(OR，0.76；95CI，0.53-1.10），或截肢(或，0.89；95CI，0.67-1.20）。对于短期到中期的结果，主要通畅性在六个月时没有差异(或，0.98；95CI，0.81-1.19），一年（或，1.12；95CI，0.97-1.30），或两年(或，1.17；95CI，0.85-1.61）随访。无截肢生存率在六个月时没有差异(OR，1.03；95CI，0.82-1.30），一年（或，1.09；95CI，0.89-1.32），两年(或，1.18；95CI，0.93-1.50)或三年(OR，1.09；95CI，0.84-1.40）随访。在总生存期或第二次通畅性方面没有发现显着差异。
结论：这项回顾性荟萃分析，非随机化，观察性研究表明，下肢动脉疾病的血管内治疗不会导致更差的围手术期，short-,与之前未接受血管内治疗的患者相比，随后的腹股沟下旁路手术的中期临床结局。
方法：三个学术数据库(Embase，PubMed,和Scopus）从成立之初到2022年8月进行了搜索。两名独立研究人员搜索了报告外周动脉疾病患者的初次搭桥手术和血管内治疗后搭桥手术结果的研究。使用重复数据抽象独立筛选摘要和全文研究。使用随机效应模型报告二分结果测量，以生成汇总比值比（OR）和95％置信区间（CI）。使用纽卡斯尔-渥太华量表评估偏倚风险。
结果：从3911篇文献中选择了17项回顾性观察性研究，包括8064例患者，其中6252人接受了初次搭桥手术，1812人接受了血管内治疗后的搭桥手术。平均年龄为69.0岁，男性占61.2％（n=4938）。对于围手术期结果，30天的结果显示死亡率没有差异(OR，0.76；95CI，0.53-1.10），或截肢(或，0.89；95CI，0.67-1.20）。对于短期到中期的结果，主要通畅性在六个月时没有差异(或，0.98；95CI，0.81-1.19），一年（或，1.12；95CI，0.97-1.30），或两年(或，1.17；95CI，0.85-1.61）随访。无截肢生存率在六个月时没有差异(OR，1.03；95CI，0.82-1.30），一年（或，1.09；95CI，0.89-1.32），两年(或，1.18；95CI，0.93-1.50)或三年(OR，1.09；95CI，0.84-1.40）随访。在总生存期或第二次通畅性方面没有发现显着差异。
结论：这项回顾性荟萃分析，非随机化，观察性研究表明，下肢动脉疾病的血管内治疗不会导致更差的围手术期，short-,与之前未接受血管内治疗的患者相比，随后的腹股沟下旁路手术的中期临床结局。
