Abstract：
OBJECTIVE: This systematic review and meta-analysis aimed to appraise recent evidence assessing patency outcomes at various time points in patients with superior vena cava, subclavian, and brachiocephalic vein stenosis who had undergone stenting.
METHODS: PubMed, Scopus, and Cochrane Library databases were searched for studies up to December 2022.
METHODS: Measured outcomes included technical success rate, primary, primary assisted, and secondary patency at various time points. A subgroup analysis was also conducted to compare malignant and benign obstruction. GRADE was used to assess the certainty of evidence.
RESULTS: Thirty nine studies reporting outcomes in 1 539 patients were included in the meta-analysis. Primary patency up to one year after the procedure was 81.5% (95% CI 74.5 - 86.9%). Primary patency declined after one year to 63.2% (95% CI 51.9 - 73.1%) at 12 - 24 months. Primary assisted patency and secondary patency at ≥ 24 months were 72.7% (95% CI 49.1 - 88.0%) and 76.6% (95% CI 51.1 - 91.1%). In the subgroup analysis, primary patency was significantly higher in patients with a malignant stenosis compared with a benign stenosis at 1 - 3 and 12 - 24 months. No significant difference was seen for pooled secondary patency rates when comparing the malignant and benign subgroups. GRADE analysis determined the certainty of evidence for all outcomes to be very low.
CONCLUSIONS: Stenting is an effective intervention for benign and malignant stenosis of the superior vena cava, subclavian, and brachiocephalic veins. Primary patency rates were good up to one year after the procedure, with 81.5% of stents retaining patency at 6 - 12 months. Patency rates declined after one year, to 63.2% primary and 89.3% secondary patency at 12 - 24 months, showing improved outcomes following re-intervention. High quality evidence is lacking. More research is needed to investigate patency outcomes and the need for surveillance or re-intervention programs.
METHODS: PubMed, Scopus, and Cochrane Library databases were searched for studies up to December 2022.
METHODS: Measured outcomes included technical success rate, primary, primary assisted, and secondary patency at various time points. A subgroup analysis was also conducted to compare malignant and benign obstruction. GRADE was used to assess the certainty of evidence.
RESULTS: Thirty nine studies reporting outcomes in 1 539 patients were included in the meta-analysis. Primary patency up to one year after the procedure was 81.5% (95% CI 74.5 - 86.9%). Primary patency declined after one year to 63.2% (95% CI 51.9 - 73.1%) at 12 - 24 months. Primary assisted patency and secondary patency at ≥ 24 months were 72.7% (95% CI 49.1 - 88.0%) and 76.6% (95% CI 51.1 - 91.1%). In the subgroup analysis, primary patency was significantly higher in patients with a malignant stenosis compared with a benign stenosis at 1 - 3 and 12 - 24 months. No significant difference was seen for pooled secondary patency rates when comparing the malignant and benign subgroups. GRADE analysis determined the certainty of evidence for all outcomes to be very low.
CONCLUSIONS: Stenting is an effective intervention for benign and malignant stenosis of the superior vena cava, subclavian, and brachiocephalic veins. Primary patency rates were good up to one year after the procedure, with 81.5% of stents retaining patency at 6 - 12 months. Patency rates declined after one year, to 63.2% primary and 89.3% secondary patency at 12 - 24 months, showing improved outcomes following re-intervention. High quality evidence is lacking. More research is needed to investigate patency outcomes and the need for surveillance or re-intervention programs.
摘要：
目的：本系统综述和荟萃分析旨在评估近期证据，评估上腔静脉患者在不同时间点的通畅性结局，锁骨下,和接受过支架置入术的头臂静脉狭窄。
方法：PubMed，Scopus,和Cochrane图书馆数据库进行了搜索，以进行截至2022年12月的研究。
方法：测量结果包括技术成功率，小学,初级辅助,和二次通畅在不同的时间点。还进行了亚组分析，以比较恶性和良性梗阻。等级用于评估证据的确定性。
结果：meta分析中纳入了报告1539例患者结局的39项研究。术后1年的原发性通畅率为81.5%（95%CI74.5-86.9%）。1年后，主要通畅率在12-24个月时下降至63.2%（95%CI51.9-73.1%）。≥24个月的一级辅助通畅率和二级通畅率分别为72.7%(95%CI49.1-88.0%)和76.6%(95%CI51.1-91.1%)。在亚组分析中，1-3个月和12-24个月时，恶性狭窄患者的原发通畅率明显高于良性狭窄。比较恶性和良性亚组时，合并的次级通畅率没有显着差异。等级分析确定所有结果的证据的确定性非常低。
结论：支架置入术是上腔静脉良恶性狭窄的有效干预措施，锁骨下,和头臂静脉.手术后1年主要通畅率良好，81.5%的支架在6-12个月时保持通畅。一年后通畅率下降，在12-24个月时，原发性通畅率为63.2%，继发性通畅率为89.3%，显示再干预后结果改善。缺乏高质量的证据。需要更多的研究来调查通畅性结果以及对监测或再干预计划的需求。
方法：PubMed，Scopus,和Cochrane图书馆数据库进行了搜索，以进行截至2022年12月的研究。
方法：测量结果包括技术成功率，小学,初级辅助,和二次通畅在不同的时间点。还进行了亚组分析，以比较恶性和良性梗阻。等级用于评估证据的确定性。
结果：meta分析中纳入了报告1539例患者结局的39项研究。术后1年的原发性通畅率为81.5%（95%CI74.5-86.9%）。1年后，主要通畅率在12-24个月时下降至63.2%（95%CI51.9-73.1%）。≥24个月的一级辅助通畅率和二级通畅率分别为72.7%(95%CI49.1-88.0%)和76.6%(95%CI51.1-91.1%)。在亚组分析中，1-3个月和12-24个月时，恶性狭窄患者的原发通畅率明显高于良性狭窄。比较恶性和良性亚组时，合并的次级通畅率没有显着差异。等级分析确定所有结果的证据的确定性非常低。
结论：支架置入术是上腔静脉良恶性狭窄的有效干预措施，锁骨下,和头臂静脉.手术后1年主要通畅率良好，81.5%的支架在6-12个月时保持通畅。一年后通畅率下降，在12-24个月时，原发性通畅率为63.2%，继发性通畅率为89.3%，显示再干预后结果改善。缺乏高质量的证据。需要更多的研究来调查通畅性结果以及对监测或再干预计划的需求。
