[HTML][HTML] Bypass surgery versus endovascular interventions in severe or critical limb ischemia
MW Steffen, N Asi, C Undavalli, Z Wang… - Journal of vascular …, 2016 - Elsevier
Journal of vascular surgery, 2016•Elsevier
Objective Critical limb ischemia is associated with a significant morbidity and mortality. We
systematically reviewed the evidence to compare bypass surgery with endovascular
revascularization in patients with critical limb ischemia. Methods We systematically searched
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus
through October 2014 for comparative studies (randomized and nonrandomized).
Predefined outcomes of interest were mortality, major amputation, patency, and wound …
systematically reviewed the evidence to compare bypass surgery with endovascular
revascularization in patients with critical limb ischemia. Methods We systematically searched
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus
through October 2014 for comparative studies (randomized and nonrandomized).
Predefined outcomes of interest were mortality, major amputation, patency, and wound …
Objective
Critical limb ischemia is associated with a significant morbidity and mortality. We systematically reviewed the evidence to compare bypass surgery with endovascular revascularization in patients with critical limb ischemia.
Methods
We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus through October 2014 for comparative studies (randomized and nonrandomized). Predefined outcomes of interest were mortality, major amputation, patency, and wound healing. We pooled odds ratios (ORs) of the outcomes of interest using the random-effects model.
Results
Nine studies that enrolled 3071 subjects were included. There was no significant difference in mortality (OR, 0.72; 95% confidence interval [CI], 0.44-1.16) or amputation (OR, 1.2; 95% CI, 0.87-1.65). Bypass surgery was associated with higher primary patency (OR, 2.50; 95% CI, 1.25-4.99) and assisted primary patency (OR, 3.39; 95% CI, 1.53-7.51). The quality of evidence was low for mortality and amputation outcomes and moderate for patency outcomes.
Conclusions
Low quality of evidence due to imprecision and heterogeneity suggests that bypass surgery and endovascular approaches may have similar effect on mortality and major amputations. However, better primary and primary assisted patency can be expected with surgery.
Elsevier