该研究旨在根据临床表现评估与髂静脉压迫综合征相关的髂静脉阻塞患者的支架初次通畅率。
对以下研究进行了系统评价和荟萃分析:未暴露的非血栓性髂静脉病变患者(NIVL,第1组)与暴露于髂动脉急性深静脉血栓形成患者(DVT,第2组);和NIVL(第1组)vs暴露于髂静脉阻塞和血栓后综合征的患者(PTS,组3)。搜索了以下数据库:EMBASE,PubMed,WebofScience,Scopus,SciELO,和LILACS。两名评审员独立选择了潜在的研究并提取了数据。显示每个结果的合并比值比(OR)和95%置信区间(95%CI)。
纳入了五项研究,共1050名参与者和1169名下肢。第五十八条下肢表现为NIVL(50.3%),91例下肢出现急性DVT(7.7%),490例下肢出现PTS(42%)。支架置入的血管内技术成功率在任何一组中都没有差异:NIVL为99.6%,94.5%急性DVT,PTS为96.5%(P=.0632)。在6个月的随访中,NIVL的主要支架通畅率为98.3%,PTS为90.9%。统计学差异显示PTS中支架通畅率降低(OR,0.17;95%CI,0.06-0.48;P=.0008;I2=0%),NIVL组的100%和急性DVT的91.6%,无统计学差异(OR,0.30;95%CI,0.06-2.32;P=.30;I2=0%)。在12个月的随访中,NIVL的主要支架通畅率为94.6%,PTS为84.1%,统计学差异显示PTS组支架通畅率降低(OR,0.29;95%CI,0.14-0.63;P=.0008;I2=0%),NIVL为91.1%,急性DVT为90.9%,无统计学差异(OR,1.03;95%CI,0.26-4.07;P=.96;I2=0%)。
与急性下肢DVT(6个月和12个月)相比,在NIVL中进行治疗时,支架的主要通畅率没有统计学差异;因此,NIVL患者接受该治疗的适应症必须考虑其他标准.然而,因为NIVL与PTS患者的支架一次通畅率有更好的结果,这一发现有利于治疗急性DVT而不是下肢PTS,一旦PTS在6个月和12个月时呈现较小的支架通畅率。
The study intended to evaluate stent primary patency rates for patients with iliac vein obstruction related with iliac vein compression syndrome according to clinic presentation.
A systematic
review and meta-analysis was conducted of studies that compared: unexposed patients with nonthrombotic iliac vein lesion (NIVL, group 1) vs exposed patients with iliac acute deep vein thrombosis (DVT, group 2); and NIVL (group 1) vs exposed patients with iliac vein obstruction and post-thrombotic syndrome (PTS, group 3). The following databases were searched: EMBASE, PubMed, Web of Science, Scopus, SciELO, and LILACS. Two reviewers independently selected the potential studies and extracted data. The pooled odds ratio (OR) and 95% confidence interval (95% CI) are shown for each outcome.
Five studies with a total of 1050 participants and 1169 lower limbs were included. Five hundred eighty-eight lower limbs presented NIVL (50.3%), 91 lower limbs presented acute DVT (7.7%), and 490 lower limbs presented PTS (42%). The endovascular technical success rate of stenting did not differ in any of the groups: 99.6% in NIVL, 94.5% in acute DVT, and 96.5% in PTS (P = .0632). The primary stent patency rates in the 6-month follow-up were 98.3% in NIVL vs 90.9% in PTS, with a statistical difference showing reduced stent patency rates in PTS (OR, 0.17; 95% CI, 0.06-0.48; P = .0008; I2 = 0%), and 100% in the NIVL group vs 91.6% in acute DVT, with no statistical difference (OR, 0.30; 95% CI, 0.06-2.32; P = .30; I2 = 0%). The primary stent patency rates in the 12-month follow-up were 94.6% in NIVL vs 84.1% in PTS, with a statistical difference showing decreases stent patency rates in the PTS group (OR, 0.29; 95% CI, 0.14-0.63; P = .0008; I2 = 0%), and 91.1% in NIVL vs 90.9% in acute DVT, with no statistical difference (OR, 1.03; 95% CI, 0.26-4.07; P = .96; I2 = 0%).
There is no statistical difference for the stent primary patency rates when the treatment is conducted in NIVL as compared with acute DVT lower limbs (at 6 and 12 months); therefore, other criteria must be considered for the indication of this treatment in NIVL patients. However, because there were better results of stent primary patency rates for NIVL vs PTS patients, this finding favors the treatment of acute DVT instead of PTS in lower limbs, once PTS renders smaller stent patency rates at 6 and 12 months.