Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries
Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries
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DOI：
10.1016/s0741-5214(02)75332-9
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发表时间：
2003-06-01
影响因子：
4.3
通讯作者：
Pereira, CAB
中科院分区：
文献类型：
--
作者：
Albers, M;Battistella, VM;Pereira, CAB
语境。关于腘下动脉聚四氟乙烯 (PTFE) 旁路移植术的报告经常使用可接受质量的生存分析来描述广泛的长期结果。理论上，如果考虑系列和时间间隔之间的差异，这些结果可能会合并。 目的：进行荟萃分析，以深入了解 PTFE 旁路移植到腘窝下动脉后的长期移植物通畅和足部保存。数据来源：从 PubMed 数据库和相关原始文章中识别出 1982 年至 2001 年发表的研究。研究选择：三名研究人员选择了 43 项研究，这些研究使用生存分析，报告了 2 年通畅率，并纳入至少 15 次旁路手术。数据提取和转换：根据标准生命表或幸存者曲线，计算每个系列中每个月的间隔成功率。将各系列的每月成功率合并起来，从而能够构建汇总幸存者曲线。数据合成：随机效应荟萃分析得出的初次移植物通畅性 5 年汇总估计值 (SE) 为 30.5% (7.6%)，二次移植物通畅性为 39.7% (5.5%)，足部保留率为 55.7% (5.0%)。在整个随访期间，与仅使用 PTFE 移植物系列相比，采用辅助手术的一系列 PTFE 移植物的汇总估计值略高。 敏感性分析：仅使用不利假设的模拟显示，所有结果在 5 年时下降了不到 5%，亚组荟萃分析中的差异较小。漏斗图表明发表偏倚的可能性不大。结论：这项荟萃分析表明，腘下动脉的 PTFE 旁路移植术取得了一定的成功，但辅助手术在远端吻合中的作用仍不确定。 (J Vasc Surg 2003；37:1263-9.)。
Context. Reports of polytetrafluoroethylene (PTFE) bypass grafting to the infrapopliteal arteries have often used survival analysis of acceptable quality to describe a wide range of long-term results. In theory, these results may be combined if variability between series and time intervals is considered.Objective: Meta-analysis was performed to gain insight into long-term graft patency and foot preservation after PTFE bypass grafting to infrapoplitcal arteries.Data source: Studies published from 1982 through 2001 were identified from the PubMed database and pertinent original articles.Study selection: Three investigators selected 43 studies that used survival analysis, reported 2-year patency rates, and included at least 15 bypass procedures.Data extraction and transformation: Based on standard life-tables or survivor curves, an interval success rate was calculated for each month in each series. The monthly success rates were combined across series, enabling construction of pooled survivor curves.Data synthesis: Random-effects meta-analysis yielded 5-year pooled estimates (SE) of 30.5% (7.6%) for primary graft patency, 39.7% (5.5%) for secondary graft patency, and 55.7% (5.0%) for foot preservation. During the entire follow-up, pooled estimates were slightly higher for series of PTFE grafts with adjunctive procedures compared with series of PTFE grafts only.Sensitivity analysis: A simulation using only unfavorable assumptions showed a decrease of less than 5% at 5 years for all outcomes, and smaller differences at subgroup meta-analysis. Funnel plots suggested that publication bias was unlikely.Conclusion: This meta-analysis indicated moderate success for PTFE bypass grafts to infrapopliteal arteries, but the role of adjunctive procedures at the distal anastomosis remains uncertain. (J Vasc Surg 2003;37:1263-9.).