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Bypass surgery versus endovascular interventions in severe or critical limb ischemia

Abd Moain Abu Dabrh1, Mark W Steffen2, Noor Asi3

  • 1Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; Knowledge Synthesis Unit, the Center for Healthcare Delivery, Mayo Clinic, Rochester, Minn.

Journal of Vascular Surgery
|September 16, 2015
PubMed

Insights

Bypass surgery and endovascular revascularization show similar outcomes for critical limb ischemia mortality and amputation. However, bypass surgery offers better patency rates, despite low-quality evidence for mortality and amputation.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Evidence-Based Medicine

Background:

  • Critical limb ischemia (CLI) presents significant morbidity and mortality risks.
  • Revascularization is crucial for limb salvage in CLI patients.

Purpose of the Study:

  • To systematically review and compare bypass surgery versus endovascular revascularization for CLI.
  • To evaluate key outcomes including mortality, amputation, patency, and wound healing.

Main Methods:

  • Systematic search of multiple databases (MEDLINE, Embase, etc.) up to October 2014.
  • Inclusion of randomized and non-randomized comparative studies.
  • Meta-analysis using random-effects models to pool odds ratios.

Main Results:

  • Nine studies with 3071 patients were analyzed.
  • No significant differences in mortality (OR 0.72) or amputation (OR 1.2) were found.
  • Bypass surgery demonstrated superior primary (OR 2.50) and assisted primary patency (OR 3.39).

Conclusions:

  • Evidence quality for mortality and amputation is low, suggesting similar outcomes between approaches.
  • Bypass surgery offers improved patency, a key factor in long-term limb salvage.
  • Further high-quality research is needed to confirm these findings.
Abstract

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