Abd Moain Abu Dabrh1, Mark W Steffen2, Noor Asi3, Chaitanya Undavalli3, Zhen Wang3, Mohamed B Elamin3, Michael S Conte4, Mohammad Hassan Murad5. 1. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn. 2. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn. 3. Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn. 4. Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, San Francisco, Calif. 5. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
Abstract
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.
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.
Authors: George A Antoniou; George S Georgiadis; Stavros A Antoniou; Ragai R Makar; Jonathan D Smout; Francesco Torella Journal: Cochrane Database Syst Rev Date: 2017-04-03
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Authors: Maria Teresa B Abola; Jonathan Golledge; Tetsuro Miyata; Seung-Woon Rha; Bryan P Yan; Timothy C Dy; Marie Simonette V Ganzon; Pankaj Kumar Handa; Salim Harris; Jiang Zhisheng; Ramakrishna Pinjala; Peter Ashley Robless; Hiroyoshi Yokoi; Elaine B Alajar; April Ann Bermudez-Delos Santos; Elmer Jasper B Llanes; Gay Marjorie Obrado-Nabablit; Noemi S Pestaño; Felix Eduardo Punzalan; Bernadette Tumanan-Mendoza Journal: J Atheroscler Thromb Date: 2020-07-04 Impact factor: 4.928
Authors: Terence E Ryan; Dean J Yamaguchi; Cameron A Schmidt; Tonya N Zeczycki; Saame Raza Shaikh; Patricia Brophy; Thomas D Green; Michael D Tarpey; Reema Karnekar; Emma J Goldberg; Genevieve C Sparagna; Maria J Torres; Brian H Annex; P Darrell Neufer; Espen E Spangenburg; Joseph M McClung Journal: JCI Insight Date: 2018-11-02