Comparativo do manejo de pacientes com doença arterial obstrutiva periférica: bypass ou angioplastia
DOI:
https://doi.org/10.34119/bjhrv7n2-145Keywords:
angioplastia, bypass, doença arterial periférica, estudo comparativoAbstract
Introdução: A Doença Arterial Obstrutiva Periférica (DAOP) é uma doença que ocorre pelo estreitamento ou bloqueio das artérias dos membros inferiores (MMII). Os principais fatores de risco para DAOP são hipertensão, diabetes mellitus (DM), hiperlipidemia, doença renal crônica e tabagismo. Objetivo: Comparar o melhor desfecho entre o bypass e a angioplastia nos pacientes com doença arterial obstrutiva periférica. Metodologia: Estudo de metanálise comparando estudos randomizados: BASIL-1, BASIL-2 e BEST-CLI, como forma de realizar a comparação, de três ensaios clínicos, sobre as técnicas bypass cirúrgico e angioplastia. Revisão de literatura: Avaliou-se o desfecho a sobrevivência livre de amputação. No BASIL-1 dos 452 pacientes, em 02 anos, 82 pacientes (37%) foram submetidos a angioplastia, enquanto que 86 pacientes (38%) realizaram bypass. No BASIL-2 avaliou-se 345 pacientes, 172 (50%) pacientes realizaram bypass venoso e 173 (50%) a angioplastia, destes 53% tiveram como desfecho primário ausência de sobrevivência livre de amputação, enquanto que o bypass apresentou 63%. No BEST-CLI houve a participação de 1830 pacientes em dois ensaios de coorte paralelos, evidenciado pelo coorte 1, 57,4% dos pacientes que realizaram angioplastia tiveram ausência de sobrevivência livre de amputação, enquanto que o bypass apresentou somente 42,6% para o mesmo desfecho. O coorte 2 não apresentou correlação estatística significativa. Discussão: No BASIL-1, entre 6 meses e 02 anos, as duas técnicas não diferiram na sobrevida livre de amputação. Já no estudo BASIL-2 avaliou-se a ausência de sobrevivência livre de amputação e mostrou que a técnica por bypass levou a um risco aumentado de 35% de amputação grave ou morte. No estudo BEST-CLI, o bypass apresentou uma taxa de morte ou amputação 32% menor em comparação com a angioplastia. Conclusão: Os estudos apresentaram resultados divergentes, não podendo concluir uma técnica estatisticamente superior no tratamento cirúrgico de DAOP.
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