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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Angioplasty versus bypass surgery in patients with critical limb ischemia-a meta-analysis
Xiaoyang Fu1, Zhidong Zhang1, Kai Liang1
1Department of Vascular and Endovascular Surgery, Henan Provincial Hospital Zhengzhou 450003, China ; Department of Vascular and Endovascular Surgery, The Affiliated People's Hospital, Zhengzhou University Zhengzhou 450003, China.
Insights
Angioplasty and bypass surgery offer similar amputation-free survival for critical limb ischemia (CLI). Angioplasty shows lower 30-day mortality, making it a potentially safer first choice for CLI patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Meta-Analysis
Background:
- Critical limb ischemia (CLI) is a severe peripheral artery disease with limited treatment options.
- Angioplasty and bypass surgery are primary interventions, but their comparative benefit-risk profiles remain debated.
- Evidence-based guidance is needed to inform clinical decision-making for CLI management.
Purpose of the Study:
- To compare the efficacy and safety of angioplasty versus bypass surgery for treating CLI.
- To evaluate outcomes including mortality, amputation-free survival, leg salvage, and re-intervention rates.
- To provide data supporting optimal treatment strategies for CLI patients.
Main Methods:
- A meta-analysis of randomized clinical trials comparing angioplasty and bypass surgery in CLI patients.
- Searches conducted in PubMed and EMBASE databases (2000-2014) using relevant keywords.
- Primary outcome: 5-year amputation-free survival; Secondary outcomes: mortality, re-interventions, and leg salvage at various time points.
Main Results:
- No significant difference in 5-year amputation-free survival between angioplasty and bypass surgery.
- Angioplasty group had significantly lower 30-day mortality (3.3%) compared to bypass surgery (6.1%).
- No significant differences observed in long-term mortality, leg salvage, or re-vascularization rates between the two approaches.
Conclusions:
- Angioplasty is non-inferior to bypass surgery for critical limb ischemia regarding amputation-free survival and overall mortality.
- Angioplasty presents a safer, less invasive, and potentially more cost-effective option.
- Angioplasty should be considered the preferred initial treatment for eligible CLI patients.
Abstract:
Background-Critical limb ischemia (CLI) is one of the most severe peripheral artery diseases. Angioplasty and bypass surgery are two major approaches for the treatment of CLI, however, it remains unclear which treatment has better benefit/risk ratio. In this paper, we performed a meta-analysis on the available clinical trials to compare these two approaches in terms of mortality, amputation-free survival, 5-year leg salvage, and freedom from surgical re-intervention. The results of this article will provide evidence based information for clinical treatment of CLI. Method-Randomized clinical trials comparing results between angioplasty and bypass surgery in CLI were identified by searching Pubmed (2000-2014) and EMBASE (2000-2014) using the search terms "angioplasty" or "bypass", "CLI" and "clinical trials". Primary outcome subjected to meta-analysis was amputation (of trial leg) free survival in 5 years. Secondary outcomes were 30-day mortality; mortality, re-interventions and leg salvage in 1, 3 and 5 years. Results-Seven clinical trials were selected for meta-analysis. No significant difference was found in the primary outcome-amputation free survival, between angioplasty and bypass surgery groups. The amputation free survival in 1, 3 and 5 years were 332/498 (66.7%), 169/346 (48.8%) and 21/60 (35%) in angioplasty group, versus 484/749 (64.6%), 250/494 (50.6%) and 46/132 (34.8%), in bypass group, respectively. The 30 days mortality rate was significantly higher in bypass treatment group [79/1304 (6.1%)] than in angioplasty group [30/918 (3.3%) [95% CI 0.55 [0.36, 0.86], P=0.008). However, there was no statistical significance in 1, 3 and 5 years mortality between these two groups. Two clinical trials showed that there was no difference in leg salvage between angioplasty and bypass surgery groups either. In addition, no difference was observed in re-vasculation between the two groups. Conclusion-Angioplasty is non-inferior to bypass surgery in regarding the amputation free survival, re-vasculation, leg amputation and overall mortality. However, angioplasty is safer, simple, and less invasive and less cost procedure. It should be considered as the first choice for feasible CLI patients.
