背景：我们研究了解剖和解剖外旁路治疗单侧髂动脉疾病的长期安全性和有效性。
方法：在PubMed上进行系统搜索，Scopus和Webofscience为2023年6月发表的文章进行了表演。我们使用DerSimonian和Laird的多变量方法进行了两阶段个体参与者数据（IPD）荟萃分析和汇总生存概率。主要终点是随访5年和10年的主要通畅性。
结果：纳入10项研究，包括1907例患者。解剖搭桥的五年和十年合并原发性通畅率为83.27％（95％CI：69.99-99.07）和77.30％（95％CI：60.32-99.04），平均主要通畅时间代表个体保持无事件的持续时间为10.08年(95%CI:8.05-10.97).解剖外搭桥的五年和十年合并原发性通畅率为77.02％（95％CI：66.79-88.80）和68.54％（95％CI：53.32-88.09），平均原发性通畅时间为9.25年，（95%CI：7.21-9.68）。在两阶段IPD荟萃分析中，解剖搭桥显示，与解剖外搭桥相比，原发性通畅性丧失的风险降低。风险比（HR）0.51（95%CI：0.30-0.85）。解剖搭桥的五年和十年二次通畅率分别为96.83％（95％CI：90.28-100）和96.13％（95％CI：88.72.3-100）。解剖外搭桥的五年和十年二次通畅率为91.39%（95%CI：84.32-99.04）和85.05%（95%CI：74.43-97.18），两组间差异无统计学意义。解剖搭桥术患者的5年和10年生存率分别为67.99%(95%CI:53.84-85.85)和41.09%(95%CI:25.36-66.57)。解剖外搭桥术的五年和十年生存率分别为70.67％（95％CI：56.76-87.98）和34.85％（95％CI：19.76-61.44）。解剖组的平均生存时间为6.92年（95％CI：5.56-7.89），解剖外组的平均生存时间为6.78年（95％CI：5.31-7.63）。汇总的30天总死亡率为2.32%（95%CI：1.12-3.87），荟萃回归分析显示发表年份与死亡率之间呈负相关（β=-0.0065，p<0.01）。进一步分析显示30天死亡率为1.29%（95%CI：0.56-2.26）与4.02%（95%CI：1.78-7.03），（p=0.02），用于2000年之后和之前发表的研究。两组之间在长期和30天死亡率方面的差异无统计学意义。
结论：虽然我们已经证明两种手术技术的长期原发性和继发性通畅性良好，解剖搭桥术降低了原发性通畅性丧失的风险,这可能反映了其在远端主动脉和对侧供体动脉中规避预期疾病进展的固有能力.在我们的综述中观察到的围手术期死亡率的降低，再加上现有文献中提出的不合时宜的人口统计学特征和纳入标准，强调了当代研究的必要性。
BACKGROUND: We investigated the long-term safety and efficacy of anatomical and extra-anatomical bypass for the treatment of unilateral iliac artery disease.
METHODS: A systematic search on PubMed, Scopus and Web of science for articles published by June 2023 was performed. We implemented a 2-stage individual participant data meta-analysis and pooled survival probabilities using the multivariate methodology of DerSimonian and Laird. The primary endpoint was primary patency at 5 and 10 years of follow-up.
RESULTS: Ten studies encompassing 1,907 patients were included. The 5- and 10-year pooled patency rates for anatomical bypass were 83.27% (95% confidence interval (CI): 69.99-99.07) and 77.30% (95% CI: 60.32-99.04), respectively, with a mean primary patency time representing the duration individuals remained event-free for 10.08 years (95% CI: 8.05-10.97). The 5- and 10-year pooled primary patency estimates for extra-anatomical bypass were 77.02% (95% CI: 66.79-88.80) and 68.54% (95% CI: 53.32-88.09), respectively, with a mean primary patency time of 9.25 years, (95% CI: 7.21-9.68). Upon 2-stage individual participant data meta-analysis, anatomical bypass displayed a decreased risk for loss of primary patency compared to extra-anatomical bypass, hazard ratio 0.51 (95% CI: 0.30-0.85). The 5- and 10-year secondary patency estimates for anatomical bypass were 96.83% (95% CI: 90.28-100) and 96.13% (95% CI: 88.72-100), respectively. The 5- and 10-year secondary patency estimates for extra-anatomical bypass were 91.39% (95% CI: 84.32-99.04) and 85.05% (95% CI: 74.43-97.18), respectively, with non-statistically significant difference between the 2 groups. The 5- and 10-year survival for patients undergoing anatomical bypass were 67.99% (95% CI: 53.84-85.85) and 41.09% (95% CI: 25.36-66.57), respectively. The 5- and 10-year survival for extra-anatomical bypass were 70.67% (95% CI: 56.76-87.98) and 34.85% (95% CI: 19.76-61.44), respectively. The mean survival time was 6.92 years (95% CI: 5.56-7.89) for the anatomical and 6.78 years (95% CI: 5.31-7.63) for the extra-anatomical groups. The pooled overall 30-day mortality was 2.32% (95% CI: 1.12-3.87) with metaregression analysis displaying a negative association between the year of publication and mortality (β =-0.0065, P < 0.01). Further analysis displayed a 30-day mortality of 1.29% (95% CI: 0.56-2.26) versus 4.02% (95% CI: 1.78-7.03), (P = 0.02) for studies published after and before the year 2000. Non-statistically significant differences were identified between the 2 groups concerning long-term and 30-day mortality outcomes.
CONCLUSIONS: While we have demonstrated favorable long-term primary and secondary patency outcomes for both surgical techniques, anatomical bypass exhibited a reduced risk of primary patency loss potentially reflecting its inherent capacity to circumvent the anticipated disease progression in the distal aorta and the contralateral donor artery. The reduction in perioperative mortality observed in our
review, coupled with the anachronistic demographic characteristics and inclusion criteria presented in the existing literature, underscores the imperative necessity for contemporary research.
