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, 7 (3), 264-271

Endovascular Versus Surgical Treatment for Acute Limb Ischemia: A Systematic Review and Meta-Analysis of Clinical Trials

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Endovascular Versus Surgical Treatment for Acute Limb Ischemia: A Systematic Review and Meta-Analysis of Clinical Trials

Tariq H Enezate et al. Cardiovasc Diagn Ther.

Abstract

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.

Figures

Figure 1
Figure 1
Data flow diagram depicting the procedure for study selection.
Figure 2
Figure 2
Funnel plot of studies show symmetry (Log risk ratio). RR, risk ratio.
Figure 3
Figure 3
Analysis of mortality at 1 month, 6 and 12 months of patient undergoing ENDO vs. SURG demonstrated no statistical difference (4,8-13). ENDO, endovascular; SURG, surgical.
Figure 4
Figure 4
Analysis of limb amputation rate at 1 month, 6 and 12 months of patient undergoing ENDO vs. SURG demonstrated no statistically significant difference (4,8-13). ENDO, endovascular; SURG, surgical.
Figure 5
Figure 5
Analysis of recurrent ischemia at 12 months in patients undergoing ENDO vs. SURG demonstrated no statistically significant difference (4,8-13). ENDO, endovascular; SURG, surgical.

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