中国普通外科杂志2025，Vol.34Issue(6)：1149-1156,8.DOI:10.7659/j.issn.1005-6947.240585
严重肢体缺血合并膝下动脉病变不同腔内治疗方法的网络Meta分析
A network Meta-analysis of the efficacy of different endovascular treatments for infrapopliteal artery disease in critical limb ischemia
摘要
Abstract
Background and Aims:Critical limb ischemia(CLI)represents the end stage of lower extremity arterial disease.Infrapopliteal artery lesions,due to their complex anatomical and pathological characteristics,pose significant therapeutic challenges,with patients facing high rates of amputation and mortality.In recent years,endovascular treatment techniques have evolved rapidly;however,controversy remains regarding the optimal treatment strategy.To systematically compare the efficacy of different treatment modalities,this study conducted a network Meta-analysis to comprehensively evaluate balloon angioplasty(BA),bare-metal stents(BMS),drug-coated balloons(DCB),drug-eluting stents(DES),and orbital atherectomy(OA)in the treatment of CLI involving infrapopliteal artery lesions,providing evidence to guide clinical decision-making on optimal endovascular therapy. Methods:A comprehensive search of multiple medical databases was performed,and 17 randomized controlled trials with a total of 2 379 patients were included.A network Meta-analysis was conducted.The primary outcomes were 1-year primary patency rate,target lesion revascularization(TLR)rate,and major amputation rate. Results:DCB showed the highest efficacy in 1-year primary patency,significantly outperforming DES(OR=4.55,95%CI=1.14-20.00),BMS(OR=15.77,95%CI=3.50-71.00),and BA(OR=9.02,95%CI=2.43-33.47).DCB also demonstrated the lowest 1-year TLR rate,significantly lower than BA(OR=0.40,95%CI=0.22-0.72).There were no statistically significant differences among treatment methods in terms of the 1-year major amputation rate;however,the cumulative ranking analysis suggested that DES may be the most effective in reducing major amputation risk. Conclusion:DCB offers clear advantages in improving primary patency and reducing TLR rates,while DES may be the most effective strategy for reducing the risk of major amputation.DCB and DES should be prioritized in the endovascular treatment of CLI involving infrapopliteal artery lesions.关键词
外周动脉疾病/慢性肢体威胁性缺血/膝下动脉/Meta分析Key words
Peripheral Arterial Disease/Chronic Limb-Threatening Ischemia/Infrapopliteal Artery/Meta-Analysis分类
医药卫生引用本文复制引用
周阳,舒畅..严重肢体缺血合并膝下动脉病变不同腔内治疗方法的网络Meta分析[J].中国普通外科杂志,2025,34(6):1149-1156,8.基金项目
湖南省长沙市科技计划重大专项基金资助项目(kh2205016). （kh2205016）
