Comparison Between Endovascular and Open Surgery for the Treatment of Peripheral Artery Diseases: A Meta-Analysis

Tang, Qianhui; Chen, Jing; Hu, Chang-fu; Zhang, Xianlan

doi:10.1016/j.avsg.2019.06.039

Cited by 25 publications

(19 citation statements)

References 42 publications

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“…With regard to in-hospital mortality, it was higher for Open Surgery than Endovascular Procedures (5.0% v. 1.2%, p=0.008). These findings are in accordance with a recent meta-analysis of twenty-seven trials (seven randomized controlled trials and twenty retrospective trials), encompassing 17,536 patients, conducted by Tang et al, which found higher mortality during follow up (10.86% v. 7.54%, p<0.05) in the open surgery group (25). The Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial, which randomized 452 patients with severe limb ischemia due to infrainguinal disease to receive either a surgery-first or an angioplasty-first strategy, determined that at one-year open surgery and angioplasty did not differ significantly in amputation-free survival (71% bypass v. 68% angioplasty; adjusted HR = 0.73, 95% CI [0.49-1.07])( 26), but at 5-years follow up bypass surgery was associated with better overall survival (47% bypass v. 41% angioplasty; adjusted HR = 0.61; 95% CI [0.50-0.75]; P < 0.009) and a non-significant difference in amputation free survival (38% bypass v. 37% angioplasty; adjusted HR = 0.85; 95% CI [0.5-1.07]; P = 0.108) (27).…”

Section: Discussionsupporting

confidence: 92%

Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Wolosker

Silva

Portugal

et al. 2021

Preprint

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ObjectivesWorldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Our objective was to analyse the surgical treatment for PAD performed in the Unified Health System of Brazil over 12 years based on publicly available data.MethodsThe study was conducted with data analysis available on the DATASUS platform of the Brazilian Health Ministry, assessing procedure technique distribution throughout the years, mortality and cost.ResultsA total of 129,424 procedures were analysed (either for claudicants or critical ischemia, proportion unknown). The vast majority of procedures were Endovascular (65.49%), with a tendency for increase in this disproportion (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the Endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental investment for these procedures was U$ 238,010,096.51, and Endovascular Procedures were on average significantly more expensive than Open Surgery (U$ 1,932.27 v. U$ 1,517.32; p=0.016).ConclusionsIn the Brazilian Public Health System, lower limb revascularizations occurred with gradual growing frequency between 2008 and 2019. Endovascular procedures were vastly more common, and related to lower in-hospital mortality rates, but higher procedural costs.

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Section: Discussionsupporting

confidence: 92%

Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Wolosker

Silva

Portugal

et al. 2021

Preprint

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“…Of these, endovascular techniques have been widely adopted because of their safety, effectiveness, and reliability. 8 , 10 …”

Section: Discussionmentioning

confidence: 99%

“…Tang et al 10 conducted a meta-analysis comparing the two types of procedures in patients with PAOD and demonstrated a significantly higher overall mortality rate for open procedures when compared to endovascular treatment (10.86% vs. 7.54%, respectively), in addition to a shorter length of hospital stay, lower rate of complications (9.48% vs. 13.60%), and lower amputation rate (12.49% vs. 18.28%) among patients treated with endovascular surgery when compared to those who underwent conventional surgery. However, there were no statistically significant differences in survival rates or limb salvage at 30-day, 1-year, or 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Doença arterial obstrutiva periférica: um estudo comparativo entre revascularizações abertas e endovasculares realizadas em caráter de urgência no sistema público de saúde do Brasil entre 2010 e 2020

et al. 2022

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RESUMO Contexto A doença arterial obstrutiva periférica apresenta alta prevalência, sendo associada a elevado risco de eventos cardiovasculares. A intervenção cirúrgica ou endovascular faz-se necessária na isquemia crítica do membro. Objetivos Avaliar a distribuição de realização de revascularizações abertas e endovasculares nas diferentes regiões do Brasil, analisando os custos para o sistema de saúde e a mortalidade relacionada a esses procedimentos. Métodos Foi realizado um estudo epidemiológico observacional transversal descritivo para avaliar as cirurgias abertas e endovasculares realizadas no sistema público de saúde do Brasil entre 2010 e 2020. Os dados foram coletados através do Departamento de Informática do SUS (Datasus). Resultados No período analisado, foram registradas 83.218 internações para realização de cirurgias abertas e endovasculares, com um custo total de R$ 333.989.523,17. Houve predominância das internações para os procedimentos percutâneos (56.132) em relação aos cirúrgicos convencionais (27.086). As Regiões Sudeste e Sul concentraram a maior parte do total de procedimentos realizados no país (83%), enquanto a Região Norte foi a que apresentou a menor taxa de internação. Observou-se uma tendência decrescente para os procedimentos abertos, e uma tendência crescente para os endovasculares. A média de permanência hospitalar foi menor nos procedimentos endovasculares (5,3 dias) em relação aos abertos (10,2 dias). Além disso, notou-se uma maior taxa de mortalidade hospitalar relacionada à revascularização aberta em relação à endovascular (5,24% versus 1,56%). Conclusões As técnicas endovasculares consistiram em uma abordagem dominante no tratamento cirúrgico da isquemia crítica, apresentando menor taxa de mortalidade hospitalar e menor tempo de internação quando comparada às cirurgias abertas.

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“…Performing angioplasty to the superficial femoral artery (SFA) is Case Report generally an inadequate treatment. It is characterized by a high degree of calcification of the SFA and the widespread involvement of the disease and a much higher prevalence of occlusion than stenosis [4] . There are a number of atherectomy devices for SFA disease including rotational atherectomy, orbital atherectomy, and excisional.…”

Section: Introductionmentioning

confidence: 99%

The rare patient with infrainguinal stent restenosis a complication: Atherectomy device fracture

Beyaz

Lale²,

Kaya³

et al. 2022

CSRC

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Excisional atherectomy alone or followed by balloon angioplasty in patients with infra-inguinal peripheral artery disease is an acceptable and appropriate treatment strategy. In this article, a case study of a 67-year-old man who had an intravascular foreign body removed due to an aterectomy device fracture while performing atherectomy due to peripheral arterial disease in the Cardiovascular Surgery Unit of our hospital is presented. The foreign body was demonstrated by a digital subtraction angiography examination. Access to the superficial femoral artery was made by an incision on the anterior 1/3 of the right thigh, and the broken atherectomy part was excised. Surgical intervention may be required to remove the intravascular foreign body that is broken during peripheral artery atherectomy. Keywords: Peripheral artery disease; atherectomy; foreign body

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Comparison Between Endovascular and Open Surgery for the Treatment of Peripheral Artery Diseases: A Meta-Analysis

Cited by 25 publications

References 42 publications

Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Doença arterial obstrutiva periférica: um estudo comparativo entre revascularizações abertas e endovasculares realizadas em caráter de urgência no sistema público de saúde do Brasil entre 2010 e 2020

The rare patient with infrainguinal stent restenosis a complication: Atherectomy device fracture

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