Acesso femoral versus acesso distal retrógrado nas angioplastias abaixo do joelho: uma revisão sistemática Cochrane
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Data
2023-12-21
Autores
Barros, Marcos Gomes Toledo [UNIFESP]
Orientadores
Vasconcelos, Vladimir [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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Resumo
Introdução: A prevalência de doença arterial obstrutiva periférica (DAOP) na população geral é de cerca de 12% a 14% e aumenta em pessoas idosas. A DAOP aumentou de 164 milhões de pessoas em 2000 para 202 milhões de pessoas em 2010. Mais de dois terços das pessoas com DAOP vivem em países de baixa ou média renda. A isquemia crítica dos membros (ICM) ocorre em 1% a 2% das pessoas com claudicação intermitente ao longo de cinco anos. Um terço das pessoas com ICM têm lesões isoladas das artérias abaixo do joelho (AAJ). ICM e lesões isoladas nas AAJ estão associadas a uma maior incidência de perda de membros quando comparadas com pessoas com doença arterial multinível. Procedimentos endovasculares como angioplastias (com ou sem stent) são amplamente utilizados para tratar lesões isoladas de AAJ, com o objetivo de melhorar o fluxo sanguíneo e salvar o membro. O sucesso técnico de qualquer procedimento de angioplastia depende da capacidade de atravessar a lesão alvo. As tentativas malsucedidas são subestimadas na literatura e as falhas no mundo real parecem ser maiores do que as relatadas. Pessoas com lesões isoladas de AAJ submetidas à angioplastia por via femoral convencional apresentam alto índice de insucesso no cruzamento dessas lesões. O acesso distal retrógrado pode oferecer algumas vantagens que podem levar ao cruzamento bem- sucedido da lesão-alvo. Objetivos: Comparar a eficácia e a segurança do acesso distal retrógrado versus o acesso femoral convencional para pessoas submetidas à angioplastias abaixo do joelho. Métodos de pesquisa: O Cochrane Vascular Information Specialist pesquisou o Cochrane Vascular Specialized Register, os bancos de dados CENTRAL, MEDLINE, Embase e CINAHL e a Plataforma Internacional de Registro de Ensaios Clínicos da Organização Mundial da Saúde e registros de ensaios clínicos ClinicalTrials.gov até 26 de setembro de 2022. Critério de seleção: Planejamos incluir ensaios clínicos controlados randomizados ou quase randomizados comparando pessoas submetidas a acesso distal retrógrado versus pessoas submetidas a acesso femoral convencional (anterógrado ipsilateral ou retrógrado contralateral) para angioplastia de AAJ. Coleta e análise de dados: Dois revisores avaliaram independentemente os estudos identificados para possível inclusão na revisão. Usamos procedimentos metodológicos padrão de acordo com o Manual Cochrane para Revisão Sistemática de Intervenções. Resultados: Não identificamos ensaios clínicos randomizados ou quasi-randomizados que atendessem aos critérios de inclusão. Conclusões dos autores: Não identificamos nenhum ensaio clínico randomizado ou quase randomizado que comparasse acesso distal retrógrado versus acesso femoral para angioplastia abaixo do joelho. São necessários estudos de alta qualidade que comparem o acesso distal retrógrado versus o acesso femoral convencional para angioplastia abaixo do joelho.
Background: The prevalence of peripheral artery disease (PAD) in the general population is about 12% to 14% and it increases in elderly people. PAD increased from 164 million people in 2000 to 202 million people in 2010. More than two-thirds of people with PAD are based in low-income or middle-income countries. Critical Limb Isquemia (CLI) occurs in 1% to 2% of people with intermittent claudication over five years. One third of people with CLI have isolated below the knee (BTK) lesions. CLI and isolated BTK lesions are associated with a higher incidence of limb loss when compared with people with multilevel arterial disease. Endovascular procedures such as angioplasty (with or without stenting) are widely used to treat isolated BTK lesions, aiming to improve blood flow and limb salvage. The technical success of any angioplasty procedure depends on the ability to cross the target lesion. Failed attempts are underestimated in the literature and failures in the real world appear to be higher than reported. People with isolated BTK lesions undergoing angioplasty by conventional femoral access present a high failure rate to cross these lesions. Retrograde distal access may provide some advantages that can lead to successful crossing of the target lesion. Objectives: To compare the effectiveness and safety of retrograde distal access versus conventional femoral access for people undergoing below the knee angioplasty. Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 September 2022. Selection criteria: We planned to include randomized or quasi-randomized controlled clinical trials comparing people undergoing retrograde distal access versus people undergoing conventional femoral access (ipsilateral antegrade or contralateral retrograde) for BTK angioplasty. Data collection and analysis: Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions. Main results: We identified no randomized or quasi-randomized clinical trials that met the inclusion criteria. Authors' conclusions: We identified no randomized or quasi randomized clinical trials that compared retrograde distal access versus femoral acces for below the knee angioplasty. High- quality studies that compare retrograde distal access versus conventional femoral access for below the knee angioplasty are needed.
Background: The prevalence of peripheral artery disease (PAD) in the general population is about 12% to 14% and it increases in elderly people. PAD increased from 164 million people in 2000 to 202 million people in 2010. More than two-thirds of people with PAD are based in low-income or middle-income countries. Critical Limb Isquemia (CLI) occurs in 1% to 2% of people with intermittent claudication over five years. One third of people with CLI have isolated below the knee (BTK) lesions. CLI and isolated BTK lesions are associated with a higher incidence of limb loss when compared with people with multilevel arterial disease. Endovascular procedures such as angioplasty (with or without stenting) are widely used to treat isolated BTK lesions, aiming to improve blood flow and limb salvage. The technical success of any angioplasty procedure depends on the ability to cross the target lesion. Failed attempts are underestimated in the literature and failures in the real world appear to be higher than reported. People with isolated BTK lesions undergoing angioplasty by conventional femoral access present a high failure rate to cross these lesions. Retrograde distal access may provide some advantages that can lead to successful crossing of the target lesion. Objectives: To compare the effectiveness and safety of retrograde distal access versus conventional femoral access for people undergoing below the knee angioplasty. Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 September 2022. Selection criteria: We planned to include randomized or quasi-randomized controlled clinical trials comparing people undergoing retrograde distal access versus people undergoing conventional femoral access (ipsilateral antegrade or contralateral retrograde) for BTK angioplasty. Data collection and analysis: Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions. Main results: We identified no randomized or quasi-randomized clinical trials that met the inclusion criteria. Authors' conclusions: We identified no randomized or quasi randomized clinical trials that compared retrograde distal access versus femoral acces for below the knee angioplasty. High- quality studies that compare retrograde distal access versus conventional femoral access for below the knee angioplasty are needed.
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Citação
BARROS, Marcos Gomes Toledo. Acesso femoral versus acesso distal retrógrado nas angioplastias abaixo do joelho: uma revisão sistemática Cochrane. 2023. 123 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.