Repair of Aneurysmal Arteriovenous Fistulae: A Systematic Review and Meta-analysis.
Repair of Aneurysmal Arteriovenous Fistulae: A Systematic Review and Meta-analysis.
复制标题
动脉瘤性动静脉瘘的修复：系统评价和荟萃分析。
DOI：
10.1016/j.ejvs.2019.07.033
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发表时间：
2019
影响因子：
5.7
通讯作者：
S. O’Neill
中科院分区：
文献类型：
--
作者：
P. Baláž;S. Rokošný;Jan Bafrnec;A. Whitley;S. O’Neill
目的：在透析患者中，由动静脉瘘引起的动脉瘤是一种常见的发现，具有急性出血的危险。本研究的目的是进行系统回顾和荟萃分析，评估动脉瘤性动静脉瘘的手术治疗选择。方法对1973年1月至2019年3月发表的有关动静脉瘘动脉瘤手术治疗的文章进行系统回顾和荟萃分析。结果共鉴定记录794份。在删除重复和低质量的研究后，对72篇全文文章进行了审查，其中13篇被纳入meta分析。患者总数为597例。289例（59%）动脉瘤位于上臂，动脉瘤最小直径为15mm。513例（86%）患者中最常见的治疗指征是预防出血。在所有13项研究中，动脉瘤吻合都是手术方法的选择。12个月时原发性通畅率为82% （95% CI 69%-90%， 12项研究，I2= 84%,p< 0.01）。采用外部假体加固的动脉瘤修补术的12个月原发性通畅率（85%,95% CI 71%-93%， 2项研究，I2= 0%,p= 0.33）与使用吻合器的动脉瘤修补术（74%,95% CI 61%-83%， 4项研究，I2= 0%,p= 0.48）和不使用吻合器的动脉瘤修补术（82%,95% CI 60%-94%， 6项研究，I2= 92%,p< 0.01）相似。结论动静脉瘘的动脉瘤造影是一种短期和长期效果良好的手术，并发症少，动脉瘤复发率低。
ObjectiveAneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae.MethodsA systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms.ResultsA total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%–90%, 12 studies,I2= 84%,p< .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%–93%, two studies,I2= 0%,p= .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%–83%, four studies,I2= 0%,p= .48) and without a stapler (82%, 95% CI 60%–94%, six studies,I2= 92%,p< .01).ConclusionAneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.