■为了识别和严格评估关于真实肱动脉瘤的文献,探索其人口特征,病因学,临床表现和不同的修复方法以及并发症发生率,以确定未来的治疗策略。
方法:系统评价在Liaquat国立医院进行,卡拉奇,从2021年9月30日至2022年11月30日,符合系统审查和荟萃分析指南的首选报告项目。文献在MEDLINE上搜索,EMBASE和Cochrane数据库,用于英语或英文翻译的相关研究,直到2022年5月31日发布。用于搜索的关键词是“肱动脉瘤”。在形式上记录数据,并进行描述性分析。
结果:在113篇文章中,6项(5.3%)为回顾性研究,7例(6.1%)为病例系列,100例(88.4%)为病例报告。涉及的患者总数为157,平均年龄为43.1±23.4岁(范围:2个月至84岁)。152例(96.8%)患者提到了性别;男性111例(73%),女性41例(27%)。真肱动脉瘤的平均直径为36.2±17.5mm,106例(67.5%)患者出现局部肿胀,65(41.4%)疼痛,41(26.1%)有远端缺血症状,28例(17.8%)正中神经受压。真正的肱动脉动脉瘤在患有动静脉瘘病史的肾衰竭患者中更为常见,并且由于肾移植81(51.5%)而使用免疫抑制剂药物。较不常见的原因包括原发性/特发性27(17.1%),外伤13(8.2%),结缔组织疾病8(5%)和血管炎7(4.5%)。142例(90.4%)是动脉瘤切除术,肢体血运重建主要是反向大隐静脉移植物79(50.3%),其次是肱动脉端对端吻合术17(10.8%)和人工移植17(10.8%)。在6例(3.8%)中进行了血管内介入治疗,以排除真肱动脉瘤。并重新建立足够的血液流向相关的肢体。
■真肱动脉瘤,虽然罕见,如果忽视,可能会导致严重的神经和血管问题。动静脉瘘和免疫抑制被认为是真正的肱动脉瘤发展的两个重要危险因素。因此,建议对肾功能衰竭患者进行有效的长期随访,以预防其并发症。开放手术修复一直是首选的治疗方式,但是需要进一步的重要研究来探索和比较不同的手术干预模式,比如开放和血管内,计划未来的治疗策略。
UNASSIGNED: To identify and critically appraise literature on true brachial artery aneurysm, exploring its demographic characteristics, aetiologies, clinical manifestations and different methods of repair along with complication rates to determine future treatment strategies.
METHODS: The systematic
review was conducted at Liaquat National Hospital, Karachi, from September 30, 2021, to November 30, 2022, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature was searched on MEDLINE, EMBASE and Cochrane databases for relevant studies in English language or with English translation published till May 31, 2022. The key words used for the search were \"brachial artery aneurysm\". Data was noted on a proforma and was subjected to descriptive analysis.
RESULTS: Of 113 articles, 6 (5.3%) were retrospective studies, 7 (6.1%) were case series and 100 (88.4%) were case reports. The total number of patients involved was 157 with mean age 43.1±23.4 years (range: 2 months to 84 years). The gender was mentioned for 152(96.8%) patients; 111(73%) males and 41(27%) females. The mean diameter of true brachial artery aneurysm was 36.2 ±17.5mm and 106(67.5%) patients presented with localised swelling, 65(41.4%) with pain, 41(26.1%) with distal ischaemic symptoms, and 28(17.8%) with median nerve compression. True brachial artery aneurysms were more common in renal failure patients having a history of arteriovenous fistula creation in the affected limb and were on immunosuppressant drugs due to renal transplant 81(51.5%). Less common causes included primary/idiopathic 27(17.1%), trauma 13(8.2%), connective tissue disorders 8(5%) and vasculitis 7(4.5%). The treatment of choice was aneurysmectomy in 142(90.4%) cases, with revascularisation of limb primarily with reversed great saphenous vein graft 79(50.3 %), followed by end-to-end anastomosis of brachial artery 17(10.8%) and synthetic grafting 17(10.8%). Endovascular intervention was performed in 6(3.8%) cases to exclude true brachial artery aneurysm, and to re-establish adequate blood flow to the associated limb.
UNASSIGNED: True brachial artery aneurysm, although a rarity, may lead to significant neurological and vascular problems if ignored. Arteriovenous fistula and immunosuppression are identified as two significant risk factors in the development of true brachial artery aneurysm. Therefore, an effective long-term follow up in renal failure patients is recommended to prevent its complications. Open surgical repair has been the most preferred mode of treatment, but further significant studies are needed to explore and compare different modes of surgical intervention, like open versus endovascular, to plan future treatment strategies.