Author + information
- Jad Omran1,
- Obai Abdullah2,
- Belal Firwana3,
- Beau Hawkins4,
- Mazen Abu-Fadel4,
- Christopher White5,
- William A. Gray6,
- Herbert Aronow7 and
- Ashraf Al-Dadah8
- 1University of Missouri-Columbia, Columbia, MO
- 2University of Florida, Gainesville, FL
- 3University of Missouri-Columbia, Columbia, MO
- 4University of Oklahoma HSC, Oklahoma City, OK
- 5Ochsner Medical Center, New Orleans, LA
- 6Columbia University Medical Center, New York, United States
- 7St. Joseph Mercy Hospital, Ann Arbor, MI, Ypsilanti, United States
- 8Prairie Cardiovascular Consultants, Ltd., Springfield, IL
A number of small studies have suggested that outcomes following endovascular therapy (ENDO) are comparable to those following surgical revascularization (SURG) for patients presenting with acute limb ischemia (ALI). We sought to compare mortality, limb amputation and recurrent ischemia across both strategies.
MEDLINE, EMBASE and CENTRAL electronic databases were comprehensively searched from January 1990 through May 2015 to identify studies of ENDO versus SURG for ALI. Two independent reviewers selected studies and extracted the data. Random-effects meta-analysis was used to pool results across studies. Heterogeneity of treatment effect among trials was assessed using the I2 statistics. The primary endpoints were mortality and limb amputation at 1, 6 and 12 months. Secondary endpoint was recurrent ischemia at one year.
A total of 1947 patients were included from 7 studies (6 prospective and 1 retrospective) comparing ENDO and SURG in the setting of ALI. Mean age was 67 years and 65% of patients were male. There was no difference in mortality between groups at 1 (risk ratio [RR] for ENDO vs. SURG is 0.72, 95% confidence interval [CI] 0.36 to 1.42), 6 (RR 0.85, CI 0.55 to 1.32) or 12 months (RR 0.72, CI 0.39 to 1.35). Similarly, there was no difference in limb amputation rates across groups at 1 (0.79, CI 0.48 to 1.29), 6 (RR 1.07, CI 0.73 to 1.55) or 12 months (RR 0.85, CI 0.58 to 1.25). ENDO was associated with significantly greater likelihood of recurrent ischemia at one year compared with SURG (RR 1.64, CI 1.19 to 2.26).
|Endovascular Intervention (ENDO)||Surgical Intervention (SURG)|
|Study/Year||N||Study primary endpoint(s)||Recurrent ischemia||Death at 1 months||Death at 6 months||Death at 1 year||Amputation at 1 months||Amputation at 6 months||Amputation at 1 year||N||Recurrent Ischemia||Death at 1 month||Death at 6 months||Death at 1 year||Amputation at 1 months||Amputation at 6 months||Amputation at 12 months|
|Comerota 1996 (STILE II)||78||Death/Amputation/Recurrent ischemia||57||3||N/A||5||6||N/A||14||46||23||0||N/A||0||7||N/A||14|
|Groar 1994 (STILE)||248||Death/Amputation/Recurrent ischemia||134||10||16||N/A||13||29||N/A||144||37||7||12||N/A||9||15||N/A|
|Nillson 1991||11||Recurrent ischemia||6||0||N/A||N/A||0||N/A||N/A||9||3||0||N/A||N/A||2||N/A||N/A|
|Ouriel 1996 (TOPAS)||155||Amputation free survival at 6 months||N/A||6||11||14||15||31||43||58||N/A||3||7||9||8||15||20|
|Ouriel 1998||272||Amputation free survival at 6 months||N/A||23||43||54||45||48||58||272||551||16||33||46||31||41||51|
|Taha 2015||154||Limb salvage/survival||75||4||N/A||19||10||N/A||20||326||140||39||N/A||110||44||N/A||64|
|Weaver 1996||150||Death/Amputation/Recurrent ischemia||79||6||11||16||4||10||15||87||20||7||11||13||0||0||0|
In patients presenting with ALI, ENDO and SURG approaches have similar associated rates of mortality and limb amputation, but recurrent ischemia is more likely following ENDO.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention
Acute limb ischemia, Endovascular therapy, Surgery