Background: A number of small studies have suggested that outcomes following endovascular (ENDO) therapy are comparable to those following surgical (SURG) revascularization for patients presenting with acute limb ischemia (ALI). We sought to compare mortality, limb amputation and recurrent ischemia across both revascularization strategies.
Methods: A comprehensive database search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases from January 1990 through January 2016 was performed to identify studies of ENDO versus SURG for ALI. Two independent reviewers selected studies and extracted the data. Random-effects meta-analysis was used to pool results across studies. Heterogeneity of treatment effect among trials was assessed using the I2 statistics. The primary endpoints were mortality and limb amputation at 1 month, 6 and 12 months. Secondary endpoint was recurrent ischemia at one year.
Results: A total of 1,773 patients were included from six studies (five randomized prospective and one observational retrospective) comparing ENDO and SURG in the setting of ALI. The mean age was 67 years and 65% of patients were male. There were no differences in mortality between the two groups at 1 month [risk ratio (RR) for ENDO vs. SURG is 0.70; 95% confidence interval (CI), 0.33 to 1.50], 6 months (RR 1.12; CI, 0.78 to 1.61) or 12 months (RR 0.74; CI, 0.29 to 1.85). Similarly, there was no significant difference in amputation rates between ENDO and SURG at 1 month (RR 0.75; CI, 0.40 to 1.42), 6 months (RR 0.87; CI, 0.52 to 1.48) or 12 months (RR 0.81; CI, 0.55 to 1.18). When looking into secondary outcomes, recurrent ischemia was not different between the two groups (RR 1.12; CI, 0.75 to 1.67).
Conclusions: In patients presenting with ALI (<2 weeks of duration), ENDO and SURG approaches have similar rates of short-term and 12 month mortality, limb amputation and recurrent ischemia.
Keywords: Acute limb ischemia (ALI); catheter directed therapy; endovascular intervention (ENDO intervention); surgical revascularization (SURG revascularization).
Conflict of interest statement
Conflicts of Interest: The authors have no conflicts of interest to declare.
Comparative Effectiveness of Endovascular Versus Surgical Revascularization for Acute Lower Extremity IschemiaAG Taha et al. J Vasc Surg 61 (1), 147-54. PMID 25080883.In patients presenting with class II ALI, ER or surgical OR resulted in comparable limb salvage rates. Although technical success is higher with OR for patients presentin …
Endovascular-first Approach Is Not Associated With Worse Amputation-Free Survival in Appropriately Selected Patients With Critical Limb IschemiaK Garg et al. J Vasc Surg 59 (2), 392-9. PMID 24184092.At 5 years, endo-first and open-first revascularization strategies had equivalent LS rates and AFS in patients with critical limb ischemia when properly selected. A patie …
Autologous Bone Marrow-Derived Cell Therapy in Patients With Critical Limb Ischemia: A Meta-Analysis of Randomized Controlled Clinical TrialsM Teraa et al. Ann Surg 258 (6), 922-9. PMID 23426345. - Meta-AnalysisThis meta-analysis underlines the promising potential of BM-derived cell therapy in CLI patients. Importantly, the results of placebo-controlled and non-placebo-controlle …
Bone Marrow Derived Cell Therapy in Critical Limb Ischemia: A Meta-analysis of Randomized Placebo Controlled TrialsSM Peeters Weem et al. Eur J Vasc Endovasc Surg 50 (6), 775-83. PMID 26460286. - ReviewThis meta-analysis of placebo controlled trials showed no advantage of stem cell therapy on the primary outcome measures of amputation, survival, and amputation free surv …
A Meta-Analysis to Compare Dacron Versus Polytetrafluroethylene Grafts for Above-Knee Femoropopliteal Artery BypassIJ Rychlik et al. J Vasc Surg 60 (2), 506-15. PMID 24973288. - ReviewCurrent evidence suggests that Dacron prosthetic grafts are superior to PTFE grafts in above-knee femoropopliteal arterial bypass procedures. Further randomized trials ta …
Cited by 3 PubMed Central articles
Acute Limb Ischemia: An Update on Diagnosis and ManagementDM Olinic et al. J Clin Med 8 (8). PMID 31416204. - ReviewThis review presents an update on the diagnosis and management of acute limb ischemia (ALI), a severe condition associated with high mortality and amputation rates. A com …
Endovascular Strategies in the Management of Acute Limb IschemiaB Lind et al. Vasc Specialist Int 35 (1), 4-9. PMID 30993101. - ReviewAcute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of li …
Acute Brachial Artery Occlusion in an Elderly Patient With Acute Myocardial IschemiaGO Ologun et al. Cureus 9 (9), e1700. PMID 29159007. - Case ReportsWe present a case of left upper extremity paresis secondary to acute brachial artery occlusion in an elderly female with active non-ST segment elevation myocardial ischem …