PDF(Pubmed)
Abstract：
For traumatic lower extremity artery injury, it is unclear whether it is better to perform endovascular therapy (ET) or open surgical repair (OSR). This study aimed to compare the clinical outcomes of ET versus OSR for traumatic lower extremity artery injury.
The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates.
A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21-0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20-0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75-1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%-27%).
Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay.
The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates.
A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21-0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20-0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75-1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%-27%).
Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay.
摘要：
目的：对于创伤性下肢动脉损伤，尚不清楚血管内治疗(ET)或开放手术修复(OSR)是否更好.本研究旨在比较ET与OSR治疗外伤性下肢动脉损伤的临床疗效。
方法：Medline，Embase,搜索Cochrane数据库进行研究。队列研究和报告ET或OSR结果的病例系列符合纳入条件。Robins-I工具和18项工具用于评估偏倚风险。主要结果是截肢。次要结果包括筋膜切开术或筋膜室综合征，死亡率,住院时间和下肢神经损伤。我们使用随机效应模型来计算合并估计。
结果：共有32项具有低或中度偏倚风险的研究纳入荟萃分析。结果显示，与接受OSR的患者相比，接受ET的患者发生大截肢（OR=0.42，95％CI0.21-0.85；I2=34％）和筋膜切开术或筋膜室综合征（OR=0.31，95％CI0.20-0.50，I2=14％）的风险显着降低。两组的全因死亡率无显著差异(OR=1.11,95%CI0.75-1.64,I2=31%)。ET修复患者的住院时间短于OSR修复患者（MD=-5.06，95％CI-6.76至-3.36，I2=65％）。术中神经损伤仅在OSR患者中报告，合并发生率为15％（95％CI6％-27％）。
结论：血管内治疗可能是创伤性下肢动脉损伤患者的更好选择。因为它可以降低截肢的风险，筋膜切开术或筋膜室综合征，神经损伤,以及更短的停留时间。
方法：Medline，Embase,搜索Cochrane数据库进行研究。队列研究和报告ET或OSR结果的病例系列符合纳入条件。Robins-I工具和18项工具用于评估偏倚风险。主要结果是截肢。次要结果包括筋膜切开术或筋膜室综合征，死亡率,住院时间和下肢神经损伤。我们使用随机效应模型来计算合并估计。
结果：共有32项具有低或中度偏倚风险的研究纳入荟萃分析。结果显示，与接受OSR的患者相比，接受ET的患者发生大截肢（OR=0.42，95％CI0.21-0.85；I2=34％）和筋膜切开术或筋膜室综合征（OR=0.31，95％CI0.20-0.50，I2=14％）的风险显着降低。两组的全因死亡率无显著差异(OR=1.11,95%CI0.75-1.64,I2=31%)。ET修复患者的住院时间短于OSR修复患者（MD=-5.06，95％CI-6.76至-3.36，I2=65％）。术中神经损伤仅在OSR患者中报告，合并发生率为15％（95％CI6％-27％）。
结论：血管内治疗可能是创伤性下肢动脉损伤患者的更好选择。因为它可以降低截肢的风险，筋膜切开术或筋膜室综合征，神经损伤,以及更短的停留时间。
