Comparison Between Endovascular and Open Surgery for the Treatment of Peripheral Artery Diseases: A Meta-Analysis

The purpose of the study is to compare the efficacy and safety between endovascular surgery and open surgery for the treatment of peripheral arterial disease (PAD). Studies were recruited from EMBASE, PubMed, Cochrane Library, and reviewing reference lists of related studies between June 2017 and December 31, 2018. Data of functional outcomes were extracted in this meta-analysis. Odds ratio or standardized mean differences with its 95% confidence interval (95% CI) were used. Pooled data proved to be absent of heterogeneity were tested by a fixed-effects model; otherwise, we used a random-effects model. All analyses were managed with RevMan 5.3 software (Cochrane Collaboration, London, UK). Twenty-seven trials (7 randomized controlled trials and 20 retrospective trials) involving a total of 17,536 participants were included in our meta-analysis. Data showed that endovascular surgery was accompanied with lower complication rate (426/4,496 [9.48%] vs. 551/4,051 [13.60%]; 95% CI, 0.53 [0.34, 0.82]; I² = 83%; P = 0.004) and shorter hospital stay (95% CI, -4.01 [-4.99, -3.02]; I² = 76%; P < 0.00001) than open surgery. Higher amputation (204/1,633 [12.49%] vs. 228/1,247 [18.28%]; 95% CI, 0.72 [0.59, 0.89]; I² = 12%; P = 0.002) and mortality during follow-up (490/4,514 [10.86%] vs. 341/4,520 [7.54%]; 95% CI, 0.73 [0.61, 0.86]; I² = 0%; P < 0.05) were found in open surgery group. No evidence showed the rate of technical success, survival, or limb salvage reduced in endovascular surgery. In conclusion, our results showed that endovascular surgery is a promising technique for the treatment of PAD. Our data showed that endovascular surgery has less complication, shorter hospital stay, lower amputation, and mortality rate when compared with open surgery, although no significant difference was observed in survival rate, surgery success, and limb salvage.