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Intervention Review

Intravascular brachytherapy for peripheral vascular disease

  1. Monica Hansrani2,
  2. Klaus Overbeck3,
  3. Jonathan J Smout4,
  4. Gerard P Stansby1,*

Editorial Group: Cochrane Peripheral Vascular Diseases Group

Published Online: 22 APR 2002

Assessed as up-to-date: 4 JUL 2002

DOI: 10.1002/14651858.CD003504

How to Cite

Hansrani M, Overbeck K, Smout JJ, Stansby GP. Intravascular brachytherapy for peripheral vascular disease. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD003504. DOI: 10.1002/14651858.CD003504.

Author Information

  1. 1

    University of Newcastle upon Tyne, Department of Surgery, Newcastle upon Tyne, UK

  2. 2

    Billingham, UK

  3. 3

    Newcastle-upon-Tyne, UK

  4. 4

    Pen-gardden, Brynn Offa, Wrexham, UK

*Gerard P Stansby, Department of Surgery, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, NE24HH, UK. Gerard.Stansby@nuth.northy.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 APR 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

International treatment of atherosclerotic narrowed and blocked arteries involves either bypassing the blockage using a graft, widening it from the inside with a balloon, a procedure known as percutaneous transluminal angioplasty (PTA), or providing a strut to hold the vessel open, known as a stent. All of these treatments are however limited by the high numbers that fail within a year. Intravascular brachytherapy (IVBT) is the application of radiation directly to the site of vessel narrowing. It is known to inhibit the processes that lead to restenosis (narrowing) of vessels and grafts after treatment.

Objectives

The objective of this review was to assess the efficacy and complications of intravascular brachytherapy on maintaining patency after angioplasty or stent insertion in native vessels or bypass grafts of the iliac or infrainguinal arteries.

Search methods

The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched 5 July 2002), the Cochrane Controlled Trials Register (last searched Issue 2, 2002), MEDLINE, EMBASE and reference lists of relevant articles.

Selection criteria

Randomised trials of the use of brachytherapy as an adjunct to the treatment of patients with peripheral arterial diseases (PAD) or stenosed bypass grafts of the iliac or infrainguinal arteries arteries versus the procedure without brachytherapy.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Adverse events information was collected from the trials.

Main results

One trial was identified which met the inclusion criteria, involving 117 patients, mean age 71 years (43-89). The trial compared PTA versus PTA and IVBT in patients with long-segment de novo or restenotic lesions or occlusions of any length in the femoropopliteal artery. Results were provided at six month follow up in 107 patients (54 PTA alone, 53 PTA+IVBT). The results favoured adjuvant IVBT in preventing restenosis/occlusion with an odds ratio (OR) of 0.35 (95% CI 0.24 to 0.53). Analysis of subgroups showed a significant benefit of IVBT in non-diabetics, OR 0.22 (95% CI 0.07 to 0.69), in those undergoing IVBT in restenotic lesions, OR 0.32 (95% CI 0.10 to 1.01), occlusive lesions, OR 0.19 (95% CI 0.06 to 0.62) and lesions in which the PTA length was greater than 10cm, OR 0.24 (95% CI 0.09 to 0.62).

Authors' conclusions

Results from the only trial available would suggest that IVBT is effective at improving the patency of femoropopliteal arteries undergoing PTA in the short-term, particularly in non-diabetics with long occlusions (>10cm).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intravascular brachytherapy for peripheral vascular disease

Intravascular brachytherapy (radiation treatment) inside arteries or bypass grafts after angioplasty or stent surgery, may prevent arteries narrowing again, but more research is needed. Narrowed and blocked arteries can be treated by bypassing the blockage using a graft, or angioplasty (widening the artery by inserting a balloon), or inserting a stent (thin metal sleeve) to hold the artery open. However, restenosis (return of the narrowing or blockage) often occurs within a year. Intravascular brachytherapy (IVBT) aims to prevent restenosis by the application of radiation to the affected part of the artery after angioplasty or stent insertion. The review found only one small trial, which showed that IVBT reduced restenosis. However, more research is needed, especially regarding the long-term effects and complications of this treatment.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

血管內近接治療(intravascular brachytherapy)對於周邊血管疾病的影響

目前國際上對於粥樣硬化狹窄和阻塞之動脈的治療方法包括了:(1)利用一導管繞過阻塞的部分、(2)使用一個氣球由血管內部將血管擴張、(3)經皮血管成形術(percutaneous transluminal angioplasty,PTA)或是(4)提供一個可以讓血管保持暢通的管路,即所謂的支架(stent)。這些治療方法於一年內的失敗率高,因此效果有限。血管內近接治療(intravascular brachytherapy,IVBT)是一種將放射線直接置放於血管狹窄部位的應用方法,目前知道這種方法可以抑制治療後的血管或導管再度狹窄(狹窄化)。

目標

本回顧的主要目的為,使用人體之血管、或是髂動脈或腹股溝動脈之繞道組織形成之血管中,施行血管成形術或嵌入支架後,評估血管內近接治療保持血管暢通的有效性和可能產生的併發症。

搜尋策略

回顧者搜尋Cochrane Peripheral Vascular Diseases Group Trials Register (最後一次搜尋為2002年7月5日)、Cochrane Controlled Trials Register (最後一次搜尋為Issue 2, 2002)、MEDLINE、EMBASE以及相關文章的參考文獻清單。

選擇標準

對於進行周邊動脈疾病治療的患者,或是進行髂動脈或腹谷股溝動脈狹窄繞道導管治療的患者,來比較使用近接治療或不使用近接治療做為輔助療法的隨機性試驗。

資料收集與分析

有2名審閱者分別獨立的評估試驗品質和取出數據,由試驗中也收集有關副作用的資訊。

主要結論

有1試驗被確認並符合納入標準,其中涉及了117名病患、平均年齡為71歲(介於43至89歲)。這個試驗對於股動脈(femoropopliteal artery)中出現長段新生的病變、再狹窄化的病變或是任何長度的阻塞之患者,比較使用 PTA 和 PTA 併用血管內近接治療的效果。在107名患者(54名患者只進行 PTA ,53名患者進行 PTA 併用血管內近接治療)進行6個月的後續追蹤後,研究結果較傾向於以使用血管內近接治療來預防血管再狹窄/阻塞的現象,其勝算比(OR)值0.35(95% CI 0.24 – 0.53)。對於次群體進行分析的結果顯示,血管內近接治療對於下列情況具有顯著的好處:非糖尿病患者,OR值為0.22(95% CI 0.07 – 0.69);發生再狹窄病變者,OR值為0.32(95% CI 0.10 – 1.01);發生阻塞病變者,OR值0.19(5% CI 0.06 – 0.62);PTA 的長度超過10公分者,OR值為0.24(95% CI 0.09 – 0.62)。

作者結論

由唯一1個可用試驗的結果顯示,血管內近接治療可以在短期內有效改善接受股動脈經皮血管形成術(PTA)患者的血管暢通度,特別是對於非糖尿病且阻塞長度較長(超過10公分)的患者。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在進行血管形成術或是支架手術後,在血管內進行血管內近接治療(放射線治療)可能可以防止血管再度窄化,但是仍然需要進行更多的研究。血管的窄化和阻塞可以使用一接管繞過血管阻塞的部分、或是血管形成術(利用置入一個氣球來達到將血管擴張的效果)、或是放入一支架(薄金屬套管)支撐血管保持開放的狀態,但是,通常會在一年內會發生再狹窄化(血管再度阻塞或窄化)的現象。血管內近接治療的目的是希望能在進行血管形成術或動脈支架置入術後,藉由將放射線施用於血管內被影響的部位來預防血管再度窄化的情形。本回顧發現只有一個小型的試驗顯示血管內近接治療可以降低血管再狹窄化的發生,但是仍需更多試驗,特別是有關於近接治療之長期性影響和併發症的試驗。