Critical appraisal of evidence on bypass surgery versus endovascular treatment for intermittent claudication: a systematic review and meta-analysis

Lemos, Teresa M; Coelho, Andreia; Mansilha, Armando

doi:10.23736/s0392-9590.21.04791-x

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…25 Lower limb revascularization has been increasing in popularity for endovascular intervention owing to less invasiveness than bypass surgery, which was also corroborated by our result. However, bypass surgery is superior to endovascular intervention for long-term primary patency 26 ; further, Hsu et al have found that there was no significant difference in flap failure or limb salvage rate regarding the difference in revascularization between free flap reconstruction. 9 Our meta-analysis indicated a 5-year patient survival rate of 75% (95% CI, 50–88%).…”

Section: Discussionmentioning

confidence: 99%

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Shimbo

Kawamoto

Koshima

2022

J Reconstr Microsurg

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Background Combined revascularization and free flap reconstruction is one treatment method for chronic limb-threatening ischemia (CLTI) with complex wounds. The purpose of this systematic review and meta-analysis was to investigate the characteristics of this combined procedure and to assess postoperative outcomes. Methods A systematic search was performed across PubMed, Scopus, and the Web of Science for studies between January 2000 and February 2022. A random-effects meta-analysis for postoperative outcome was conducted. Results Fifteen articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment. Our meta-analysis showed the following complication rates for short-term postoperative outcomes: 37% (95% CI, 18%–53%; I2 = 74%) for reoperation, 13% (95% CI, 2%–24%; I2 = 0%) for vascular thrombosis, 9% (95% CI, 0%–17%; I2 = 0%) for total flap failure, 8% (95% CI, 0%–17%; I2 = 0%) for partial flap failure, 4% (95% CI, 0%–10%; I2 = 0%) for amputation, and 3% (95% CI, 0%–9%; I2 = 0%) for 30-day mortality. The 1-, 3-, and 5-year limb salvage rates were 86% (95% CI, 78%–92%), 81% (95% CI, 68%–88%), and 71% (95% CI, 53%–83%), respectively. The 1-, 3-, and 5-year patient survival rates were 93% (95% CI, 90%–96%), 92% (95% CI, 77%–97%), and 75% (95% CI, 50%–88%), respectively. Conclusion Combined revascularization and free flap reconstruction for CLTI with complex wounds was clearly effective for the long-term outcomes. However, this combined procedure should be considered on the assumption that the reoperation rate is high and that flap-related complications rate may be higher than lower extremity reconstruction of other etiologies.

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Section: Discussionmentioning

confidence: 99%

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Shimbo

Kawamoto

Koshima

2022

J Reconstr Microsurg

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Surgical treatment of PAD: Open and endovascular repair

Chakfe,

Bellissard

2024

Pathophysiology and Treatment of Atherosclerotic Disease in Peripheral Arteries

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Long-Term Results of Reconstructive and Recovery Operations About Chronic Critical Ischemia of the Lower Extremities

Popovych,

Korsak

2024

Khark. Surg. Sch.

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Introduction. The prevalence of obliterating diseases of the lower extremities is almost 10 – 13 % of population. This indicator continues to grow steadily and reaches 30 % of the population due to the aging population, smoking and diabetes, and constitutes a significant socio-economic problem. Aim. To evaluate the long-term results of surgical treatment of occlusive-stenotic lesions of the arteries of the lower extremities with condition of chronic critical ischemia. Materials and methods. A retrospective analysis of the long-term postoperative period was conducted in 310 patients with critical ischemia in obliterating atherosclerosis of the lower extremities. Рatients were divided into 3 groups depending on the surgical intervention performed: group I – 127 (41.0 %) patients who underwent open reconstructive interventions with restoration of main blood flow; group II – 145 (46.8 %) patients who underwent various types of endarterectomy with artery plastic surgery; Group III – 38 (12.2 %) patients who underwent repeated reconstructive interventions. Results. The patency of the reconstruction zone, the preservation of a viable limb, and the presence of general complications associated with the multifocal nature of the atherosclerotic process during the 5 and 10 year follow-up period were evaluated in all groups. In the 1st group, the patency of the reconstruction zone was noted in 64.2 % and 47.6 % of patients, and the preservation of the functional limb was noted in 84.4 % and 61.9 % of cases during 5 and 10 years of observation, respectively. In the II group, the patency of the reconstruction zone was noted in 47.7 % and 19.5 %, respectively, preservation of the reproductive limb - in 74.3 % and 47.2 % of cases, respectively. In the III group, the patency of the reconstruction zone was found in 19.4 % and 14.3 %, respectively, preservation of the reproductive limb - in 35.5 % and 28.6 % of cases, respectively. Conclusions. Surgical treatment of chronic critical ischemia of the lower extremities in the remote postoperative period allows to preserve the functional limb after shunt operations and endarterectomy in 61.9 % and 47.2 % of patients, respectively. The progressive course of obliterating atherosclerosis causes a high frequency of multifocal occlusive-stenotic lesions, which leads to an increase in the frequency of acute vascular events and high mortality in the distant postoperative period.

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Critical appraisal of evidence on bypass surgery versus endovascular treatment for intermittent claudication: a systematic review and meta-analysis

Cited by 3 publications

References 22 publications

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Surgical treatment of PAD: Open and endovascular repair

Long-Term Results of Reconstructive and Recovery Operations About Chronic Critical Ischemia of the Lower Extremities

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