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Related Experiment Videos

Bypass surgery for chronic lower limb ischaemia.

G C Leng1, M Davis, D Baker

  • 1Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, UK, NW3 2PF. rfpc0015@rfhsm.ac.uk

The Cochrane Database of Systematic Reviews
|July 25, 2000
PubMed
Summary

Surgical bypass for critical limb ischemia shows improved patency compared to angioplasty but requires more trials. Bypass surgery significantly reduces amputation rates compared to thrombolysis.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Evidence-Based Medicine

Background:

  • Surgical bypass is a primary treatment for critical limb ischemia.
  • The effectiveness of bypass surgery has not been formally evaluated.
  • This review assesses bypass surgery's impact on chronic lower limb ischemia.

Purpose of the Study:

  • To determine the effects of bypass surgery in patients with chronic lower limb ischemia.
  • To compare bypass surgery with other treatments like angioplasty, thromboendarterectomy, thrombolysis, exercise, and spinal cord stimulation.

Main Methods:

  • Systematic review of randomized controlled trials.
  • Searched Cochrane Peripheral Vascular Diseases Group trials register, MEDLINE, EMBASE, and contacted investigators.

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  • Data extracted and quality assessed independently; dichotomous data analyzed using Peto odds ratio.

    • Main Results:

    • Six trials involving over 700 patients compared bypass surgery with angioplasty, thromboendarterectomy, thrombolysis, exercise, or spinal cord stimulation.
    • Bypass surgery showed significantly higher primary patency than angioplasty at 12 months.
    • Amputation rates were significantly lower with bypass surgery compared to thrombolysis, and blood flow restoration was greater compared to thromboendarterectomy.

    Conclusions:

    • Limited evidence supports the effectiveness of bypass surgery for critical limb ischemia.
    • Further large-scale randomized controlled trials are necessary to confirm findings.
    • Bypass surgery demonstrates benefits over specific alternative treatments but requires more robust evidence.