A Systematic Review of Single vs Multivessel Recanalisation in Critical Limb Ischaemia

AimTo compare wound healing and amputation free survival outcomes in patients with critical limb threatening ischaemia (CLTI) undergoing single-vessel (SV) vs multi-vessel (MV) crural recanalisation.MethodsElectronic databases including OVID, MEDLINE, Pubmed and CINHAL was conducted up until October 1st, 2024. Eligible studies of all languages included adults with CLTI who underwent SV or MV endovascular revascularisation of the crural vessels and reported wound healing outcomes (primary outcome). Risk of bias was assessed using ROBINS-I and RoB 2 tools. Quality of evidence was assessed using the GRADE System.ResultsA total of 154 articles were screened, of which seven studies (n = 2081 patients; 2402 limbs) were included. Of these, 1520 limbs (63.8%) underwent SV and 882 (36.7%) MV recanalisation. Five studies assessed wound healing across follow-up periods ranging from 3 months to 3 years. No consistent or statistically significant differences in wound healing were found between SV and MV groups. Six studies reported amputation-free survival (AFS) at 1 year, with some showing improved outcomes in MV patients. Overall, the quality of evidence was very low due to high risk of bias, heterogeneity in outcome definitions, and imprecision.ConclusionsThere is no clear evidence that MV recanalisation improves wound healing compared to SV in patients with CLTI. While some studies suggest potential benefits in AFS and limb salvage in selected patients, the current evidence is insufficient to support the added benefit of MV strategies. High-quality randomised trials with standardised outcome reporting are needed.