■头弓狭窄(CAS)经常复发,到目前为止,对治疗的抵抗力和干预结果尚未得到很好的验证。我们旨在评估血液透析患者接受CAS治疗的临床结果。
■截至2023年12月4日搜索电子书目来源,以确定治疗CAS后报告结果的研究。通过荟萃分析和网络荟萃分析(NMA),结合直接和间接证据,比较不同治疗方式的累积排名曲线下的优势比(OR)和表面。本系统审查是根据PRISMA-P进行的。该评论在PROSPERO(CRD42022296513)中注册。
■4项随机对照试验(RCT)和15项非RCT纳入分析。研究人群的瘘管类型不同,再狭窄或血栓形成,在出版物中观察到显著的异质性。偏倚的风险低至严重。Meta分析发现DCB和PTA在6个月和12个月的原发性通畅性之间没有显着差异(OR分别为1.16和0.60;证据确定性低)。与支架或PTA相比,STG在3、6和12个月时的结果良好(OR分别为4.28、5.13和13.12,以及4.28、5.13、13.12;证据确定性低)。关于初级通畅,治疗排名,从最高到最低,是STG(92.7%),转座(76.0%),支架(67.5%),DCB(46.3%),和PTA(64.5%)在12个月。
■尽管数据有限,低质量的证据表明,当所有替代方案都适用时,STG可能值得考虑作为主要治疗选择,考虑到它们具有更好的原发性通畅性和更高的治疗排名的潜力。
UNASSIGNED: Cephalic arch stenosis (CAS) is often recurrent, resistant to treatment and the intervention outcome is not well validated so far. We purposed to assess the clinical outcomes of CAS treatment in patients with hemodialysis access.
UNASSIGNED: Electronic bibliographic sources were searched up to December 4 2023 to identify studies reported outcome after treating CAS. Direct and indirect evidence was combined to compare odds ratios (OR) and surfaces under the cumulative ranking curves across the different treatment modalities through meta-analysis and network meta-analyses (NMA). This systematic review was conducted in accordance with the PRISMA-P. The review is registered in PROSPERO (CRD42022296513).
UNASSIGNED: Four randomized controlled trials (RCTs) and 15 non-RCTs were included in the analysis. The study population differed in fistula type, restenosis or thrombosis, and significant heterogeneity was observed among the publications. The risk of bias was low to serious. Meta-analysis found no significant difference between DCB and PTA in primary patency at 6 and 12 months (OR 1.16 and 0.60, respectively; low certainty of evidence). Favorable result with STG compared to stent or PTA at 3, 6, and 12 month was observed (OR 4.28, 5.13, and 13.12, and 4.28, 5.13, 13.12, respectively; low certainty of evidence). Regarding primary patency, the treatment rankings, from highest to lowest, were STG (92.7%), transposition (76.0%), stent (67.5%), DCB (46.3%), and PTA (64.5%) at 12 months.
UNASSIGNED: Despite data limitations, the low-quality evidence suggests that STG may merit consideration as a primary treatment option when all alternatives are applicable, given their potential for better primary patency and higher treatment ranking.