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Endovascular revascularization vs. open surgical revascularization for patients with lower extremity artery disease:

Hongxin Shu1, Xiaowei Xiong2, Xiaomei Chen3

  • 1The Second Clinical Medical School, Nanchang University, Nanchang, China.

Frontiers in Cardiovascular Medicine
|August 9, 2023
PubMed

Insights

Endovascular revascularization (EVR) offers lower short-term risks for lower extremity artery disease (LEAD), while open surgical revascularization (OSR) provides better long-term outcomes. Patient life expectancy is crucial when selecting LEAD treatment.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Lower extremity artery disease (LEAD) treatment primarily involves revascularization, with endovascular revascularization (EVR) and open surgical revascularization (OSR) being common modalities.
  • The optimal revascularization strategy for LEAD remains a subject of ongoing debate and controversy within the medical community.

Purpose of the Study:

  • To provide a comprehensive review of recent evidence comparing endovascular revascularization (EVR) and open surgical revascularization (OSR) for treating lower extremity artery disease (LEAD).
  • To analyze and synthesize data from randomized controlled trials (RCTs) and cohort studies to inform clinical decision-making for LEAD management.

Main Methods:

  • A systematic literature search was conducted across Medline, Embase, and the Cochrane Library databases.
  • Included studies were randomized controlled trials (RCTs) and cohort studies comparing short-term and long-term outcomes of EVR versus OSR in LEAD patients.
  • Outcomes assessed included mortality, amputation rates, complications, cardiovascular events, hospital stay, survival, re-intervention rates, and vessel patency.

Main Results:

  • Analysis of 11 RCTs and 105 cohort studies involving 750,134 patients.
  • Pooled cohort data indicated EVR significantly reduced 30-day mortality, wound complications, MACEs, and LOS, but increased risks for OS, FFR, PP, and SP.
  • Pooled RCT data showed EVR was associated with lower 30-day mortality, fewer wound complications, and shorter LOS, but a higher risk of PP and SP. No significant difference in 30-day major amputation or AFS was observed.

Conclusions:

  • Both cohort studies and RCTs suggest EVR offers lower short-term risks for LEAD, whereas OSR demonstrates a substantially lower long-term risk.
  • The choice of revascularization modality for LEAD should carefully consider the patient's life expectancy.
  • Further high-quality studies are necessary to validate these findings, as current evidence largely relies on retrospective cohort data.
Abstract

Keywords:
endovascularlower extremity artery diseasemeta-analysisopen surgeryperipheral artery diseaserevascularizationsystematic review

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