A Systematic Review of Single vs Multivessel Recanalisation in Critical Limb Ischaemia
Lukschana Senathirajah1, Navanith Murali1,2, Angela Lee1,2
1Department of Vascular Surgery/Radiology, Norfolk and Norwich University Hospital, Norwich, UK.
Insights
Single-vessel (SV) versus multi-vessel (MV) crural recanalisation for critical limb threatening ischaemia (CLTI) shows no significant difference in wound healing. Evidence is insufficient to support MV strategies over SV, with low-quality data needing further investigation.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Limb Salvage
Background:
- Critical limb threatening ischaemia (CLTI) poses a significant risk of amputation.
- Endovascular revascularisation, including single-vessel (SV) and multi-vessel (MV) approaches, is a key treatment modality.
- The comparative effectiveness of SV versus MV crural recanalisation for wound healing and limb salvage remains unclear.
Purpose of the Study:
- To compare wound healing and amputation-free survival (AFS) outcomes in patients with CLTI.
- To evaluate the efficacy of single-vessel (SV) versus multi-vessel (MV) crural recanalisation.
- To assess the current evidence base regarding these revascularisation strategies.
Main Methods:
- A systematic review of electronic databases (OVID, MEDLINE, Pubmed, CINHAL) was conducted up to October 1st, 2024.
- Included studies focused on adult patients with CLTI undergoing SV or MV endovascular crural revascularisation.
- Risk of bias and quality of evidence were assessed using ROBINS-I, RoB 2, and GRADE System.
Main Results:
- Seven studies involving 2081 patients (2402 limbs) were included; 63.8% underwent SV and 36.7% MV recanalisation.
- No consistent or statistically significant differences in wound healing were observed between SV and MV groups.
- While some studies indicated potential AFS benefits with MV, overall evidence quality was very low due to bias and heterogeneity.
Conclusions:
- Current evidence does not clearly demonstrate that multi-vessel (MV) recanalisation improves wound healing compared to single-vessel (SV) in CLTI patients.
- The added benefit of MV strategies over SV for limb salvage is not sufficiently supported by existing data.
- High-quality randomized trials with standardized outcome reporting are essential to clarify the role of MV recanalisation in CLTI management.
Abstract:
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.