Intervenções endoluminais versus intervenções cirúrgicas em pacientes com estenose de enxerto venoso em revascularização infrainguinal: revisão sistemática Cochrane
Data
2022
Autores
Botelho, Francesco Evangelista 
Orientadores
Cacione, Daniel Guimarães
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A cirurgia de revascularização infrainguinal que utiliza um enxerto de veia safena magna, ou outro enxerto venoso autólogo, é uma opção de tratamento bem reconhecida para o tratamento da doença arterial periférica do membro inferior, incluindo isquemia crônica com risco de perda do membro e claudicação intermitente, aneurismas das artérias dos membros inferiores e grandes traumas que acometem as artérias dos membros inferiores. A cirurgia de revascularização infrainguinal tem bons resultados em termos de taxas de preservação do membro e perviedade do enxerto a longo prazo, mas é limitada pela possibilidade de falha por diversos mecanismos , como as tromboses em decorrência de estenoses no enxerto. A detecção de estenoses por meio de vigilância clínica e ultrassonográfica, seguida de tratamento, é empregada para evitar a oclusão do enxerto. A abordagem convencional para o tratamento de pacientes com estenose do enxerto, após revascularização infrainguinal, consiste no reparo cirúrgico aberto, que geralmente é realizado sob bloqueio regional. O tratamento endoluminal com angioplastia é menos invasivo e usa anestesia local. Ambos os métodos visam preservar a perviedade do enxerto venoso, ameaçada pela ocorrência da estenose. Objetivo: A revisão sistemática visa avaliar a eficácia das intervenções endoluminais versus intervenções cirúrgicas em pacientes com estenose de enxerto venoso em revascularização infrainguinal. Métodos: O grupo vascular Cochrane pesquisou o registro especializado vascular Cochrane, o registro central de ensaios clínicos da Cochrane (CENTRAL), MEDLINE, Embase, CINAHL, a plataforma de registro de ensaios clínicos da Organização Mundial da Saúde, e o site ClinicalTrials.gov. com a última busca realizada em 25 de agosto de 2020. Critérios de seleção: foram incluídos todos os ensaios clínicos randomizados (ECRs), publicados e não publicados, que compararam intervenções endoluminais versus intervenções cirúrgicas em pacientes com estenose de enxerto venoso em revascularização infrainguinal. Coleta e análise de dados: Dois autores, independentemente analisaram os estudos identificados com potencial de inclusão na revisão. Foram utilizados os procedimentos metodológicos padronizados de acordo com o Cochrane Handbook for Systematic Review of Interventions. Resultados: Não identificamos nenhum ensaio clínico randomizado que se encaixasse nos critérios de inclusão. Conclusão: Não encontramos ensaios clínicos randomizados que comparassem intervenções endoluminais versus intervenção cirúrgica para tratamento dos pacientes com estenose de enxerto venoso em revascularização infrainguinal. Atualmente, não existem evidências consistentes da superioridade clínica da abordagem endoluminal versus tratamento cirúrgico ou vice-versa. Estudos de alta qualidade são necessários para fornecer evidências sobre o tratamento da estenose de enxertos venosos, após revascularização infrainguinal.
Bypass surgery using a large saphenous vein graft, or another autologous venous graft, is a well-recognized treatment option for managing peripheral arterial disease of the lower limb, including chronic limb-threatening ischemia (CLTI) and intermittent claudication, peripheral limb aneurysms, and major limb arterial trauma. Bypass surgery has good results in terms of limb preservation rates and long-term graft patency but is limited by the possibility of vein graft failure due to stenoses of the graft. Detection of stenoses through clinical and ultrasonographic surveillance, followed by treatment, is used to avoid graft occlusion. The conventional approach to treatment of patients with graft stenosis following infrainguinal bypass consists of open surgical repair, which usually is performed under general anesthesia. Endoluminal treatment with angioplasty is less invasive and uses local anesthesia. Both methods aim to improve blood flow to the limb. Objectives:To perform a systematic review to assess the effectiveness of endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to 25 August 2020.Selection criteria: We aimed to include all published and unpublished randomized controlled trials (RCTs) that compared endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. Data collection and analysis: Two review authors independently assessed all identified studies for potential inclusion in the review. We aimed to use standard methodological procedures in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The main outcomes of interest were primary patency, primary assisted patency, and all-cause mortality. Results: We identified no RCTs that met the inclusion criteria for this review. Conclusions: We found no RCTs that compared endoluminal interventions versus surgical intervention for stenosis in vein grafts following infrainguinal bypass. Currently, there is no high-certainty evidence to support the use of one type of intervention over another. High-quality studies are needed to provide evidence on managing vein grafts stenosis following infrainguinal bypass.
Bypass surgery using a large saphenous vein graft, or another autologous venous graft, is a well-recognized treatment option for managing peripheral arterial disease of the lower limb, including chronic limb-threatening ischemia (CLTI) and intermittent claudication, peripheral limb aneurysms, and major limb arterial trauma. Bypass surgery has good results in terms of limb preservation rates and long-term graft patency but is limited by the possibility of vein graft failure due to stenoses of the graft. Detection of stenoses through clinical and ultrasonographic surveillance, followed by treatment, is used to avoid graft occlusion. The conventional approach to treatment of patients with graft stenosis following infrainguinal bypass consists of open surgical repair, which usually is performed under general anesthesia. Endoluminal treatment with angioplasty is less invasive and uses local anesthesia. Both methods aim to improve blood flow to the limb. Objectives:To perform a systematic review to assess the effectiveness of endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to 25 August 2020.Selection criteria: We aimed to include all published and unpublished randomized controlled trials (RCTs) that compared endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. Data collection and analysis: Two review authors independently assessed all identified studies for potential inclusion in the review. We aimed to use standard methodological procedures in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The main outcomes of interest were primary patency, primary assisted patency, and all-cause mortality. Results: We identified no RCTs that met the inclusion criteria for this review. Conclusions: We found no RCTs that compared endoluminal interventions versus surgical intervention for stenosis in vein grafts following infrainguinal bypass. Currently, there is no high-certainty evidence to support the use of one type of intervention over another. High-quality studies are needed to provide evidence on managing vein grafts stenosis following infrainguinal bypass.