Meta-Analysis of Randomised Controlled Trials Comparing Bypass and Endovascular Revascularisation for Peripheral...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health

Background:

• Peripheral artery disease (PAD) affects 250 million globally.
• Optimal revascularization strategy for PAD remains unclear despite numerous trials.
• Recent BEST-CLI and BASIL-2 trials offer data but with discordant findings.

Purpose of the Study:

• To systematically review and meta-analyze worldwide randomized evidence comparing bypass surgery and endovascular revascularization for lower limb PAD.
• To clarify the optimal revascularization approach by synthesizing current evidence.

Main Methods:

• Comprehensive literature search of MEDLINE, Embase, and CENTRAL up to May 7, 2023.
• Included randomized controlled trials comparing bypass and endovascular revascularization for lower limb PAD.
• Primary outcome: major amputation. Secondary outcomes: mortality, re-intervention, and 30-day adverse events. Analyzed using random-effects model and Cochrane risk of bias 2 tool.

Main Results:

• 13 studies with 3840 patients were analyzed.
• No significant difference in major amputation (OR 1.12) or mortality (OR 0.96) between bypass and endovascular groups.
• Bypass surgery significantly reduced re-intervention rates (OR 0.57) compared to endovascular treatment.

Conclusions:

• Major amputation and mortality rates are comparable for bypass and endovascular interventions in PAD.
• Bypass surgery offers a significant advantage by lowering the rate of re-intervention post-operatively.