背景:传统上通过开放修复(OR)治疗p动脉瘤(PAA)。血管内修复(ER)已成为一种新的医治战略。本系统综述和荟萃分析的目的是评估和比较OR和ER在PAA急诊治疗中的当前结果。
方法:对PubMed/Medline数据库进行了系统的文献检索。结果是30天死亡率,发病率,主要截肢率(30天),主要截肢率(1年),1年主要通畅率,1年二次通畅率和1年生存率。此外,我们纳入了2009年至2021年在Martin-LutherUniversityHalle-Wittenberg接受治疗的pop动脉瘤患者的临床数据.
结果:我们从2014年和2015年确定了两项队列研究,共有199例患者接受了紧急手术(39ER和160OR)。我们还包括来自我们机构的26名患者。对于紧急治疗,30天大截肢率(18%对3%,赔率比5.82,95%CI[1.75;19.30],p=.004),30天死亡率(10%对1%,赔率比5.57,95%CI[1.01;30.58],p=.05),1年主要截肢率(15%vs6%赔率3.61,95%CI[1.18;11.09],p=.02),1年原发性通畅性丧失(54%vs23%,赔率比3.19,95%CI[0.91;11.20],p=.07),和1年二次通畅性损失(44%对12%,赔率比6.91,95%CI[3.01;15.83],与OR组相比,ER组的p<0.05)更高。
结论:腔内修复术是PAA急诊治疗的一种替代方法。来自现有非随机研究的有限证据表明,接受ER的患者预后不良。然而,结果容易出现选择偏差,只有将ER与OR进行比较的随机试验才可能揭示,在急诊情况下,ER作为PAA的主要治疗方案是否会使患者亚组受益.
BACKGROUND: Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic
review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA.
METHODS: A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg.
RESULTS: We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group.
CONCLUSIONS: Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.