Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis

Schreve, Michiel A; Vos, Cornelis G.; Vahl, A.C.; Vries, J.P.P.M. de; Kum, Steven; Borst, Gert J. de; Ünlü, Çağdaş

doi:10.1016/j.ejvs.2016.11.007

Cited by 87 publications

(74 citation statements)

References 28 publications

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“…A score of ≤8 was considered to be poor, 9–14 moderate quality, and 15–16 good quality for noncomparative studies in this review. Cutoff points were ≤14, 15–22, and 23–24, respectively, for comparative studies, which are consistent with a previous study (Schreve et al, ). Discrepancies between the authors during quality assessment were resolved by discussion.…”

Section: Methodssupporting

confidence: 92%

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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Background Limb‐salvage surgery with vascular reconstruction is the current standard treatment when sarcoma involves major vessels of the lower extremity. However, the low incidence of sarcoma and rarity of limb‐salvage surgery are limiting factors for the reliable study of limb‐salvage surgery. Therefore, a systematic review was conducted to establish better management of lower extremity sarcoma based on currently available evidence. Methods A systematic review and meta‐analysis of data on limb‐salvage surgery with vascular reconstruction for lower extremity sarcoma were conducted using MEDLINE through PubMed, Scopus, CINARL, and Cochrane Database of Systematic Reviews. Overall limb‐salvage rate was the primary outcome, and rates of perioperative complication and arterial patency were secondary outcomes. Results Among the 271 patients (18 studies) included in this study, 69.4% underwent arterial reconstruction with autologous graft, 22.0% underwent synthetic graft, and 8.6% underwent other reconstructive methods. Pooled overall limb‐salvage rate was 89.8% [95% confidence interval (CI), 85.0–93.1%] after a mean follow‐up of 19–74.7 months. Pooled overall perioperative complication and arterial patency rates were 49.5% (95% CI, 42.8–56.2%) and 85.4% (95% CI, 79.5–89.9%), respectively. Conclusions Current evidence suggests that limb‐salvage surgery with vascular reconstruction has a high limb‐salvage rate; however, the high perioperative complication rate remains problematic. Early and appropriate interventions are required to optimize the complications of limb‐salvage surgery.

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Section: Methodssupporting

confidence: 92%

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

2020

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“…There are several other techniques that have been investigated for patients with diabetes, PAD, and ulceration in whom there are no options for revascularization. These include venous arterialization and intermittent pneumatic compression therapy . However, there are insufficient data to provide any recommendation on their utility in patients where no revascularization option exists.…”

Section: Treatmentmentioning

confidence: 99%

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

257

262

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which confers a significantly elevated risk of adverse limb events and cardiovascular disease. We know that the diagnosis, prognosis, and treatment of these patients are markedly different to patients with diabetes who do not have PAD and yet there are few good quality studies addressing this important subset of patients. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to devise clinical questions and critically important outcomes in the patient‐intervention‐comparison‐outcome (PICO) format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We here present the updated 2019 guidelines on diagnosis, prognosis, and management of PAD in patients with a foot ulcer and diabetes, and we suggest some key future topics of particular research interest.

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“…At the extreme end of severe disease, patients may present with occlusion of all pedal arteries (dorsalis pedis, lateral tarsal, lateral plantar, medial plantar arteries and plantar arch) with at most collateral vessels present, termed as ‘desert foot.’ These patients have no suitable target arteries and hence are poor candidates for distal open bypass or conventional endovascular revascularization. Deep venous arterialization possibly provides the last option before amputation for these patients with a reported 1‐year limb salvage of 75% by stimulating angiogenesis and collateral formation from the venous channels.…”

Section: Conduct Of Endovascular Proceduresmentioning

confidence: 99%

“…The venous valves from the posterior tibial vein to the plantar venous arch need to be disrupted using either multiple stents or stent‐grafts or valvulotomes to allow the arterial blood to flow unimpeded along the native venous conduit. Deep venous arterialization does not require an available communication from the saphenous vein to reach the infra‐malleolar deep venous arch and requires fewer valves to be destroyed compared with superficial venous arterialization …”

Section: Conduct Of Endovascular Proceduresmentioning

confidence: 99%

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Treatment of lower limb ischaemia in patients with diabetes

Choke

Tang

Cheng

et al. 2019

Diabetes Metabolism Res

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Diabetic chronic limb‐threatening ischaemia is a challenging clinical problem with patients at high risk of diabetic foot ulceration (DFU) and limb loss. Patients often remain asymptomatic even in the presence of severe pedal ischaemia until first presenting with tissue loss such as DFU or frank gangrene. Limb salvage units should have the facilities and expertise to provide multidisciplinary team‐based holistic care through best medical therapy, rapid diagnosis, prompt revascularisation with endovascular or open surgical techniques and expert wound management. Endovascular revascularisation has become the first line strategy in contemporary clinical practice because of similar outcomes in wound healing and amputation rates in most patients when compared with open surgery. The primary goal is restoration of pulsatile in‐line blood flow to the ankle or foot, with an angiosome‐directed approach possibly achieving superior outcomes especially in diabetics with poor collaterals. A comprehensive overview of conventional endovascular techniques (such as antegrade true lumen and subintimal approaches), advanced techniques for complex disease (such as retrograde subintimal and pedal‐plantar loop approaches or even deep venous arterialisation) and the various treatment options are described. Diabetic limb salvage rates can be excellent with suitable multidisciplinary expertise and care.

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Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis

Cited by 87 publications

References 28 publications

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Limb‐salvage surgery with vascular reconstruction after lower extremity sarcoma resection: A systematic review and meta‐analysis

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Treatment of lower limb ischaemia in patients with diabetes

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