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Wang G, Li H, Chen B, Guo P, Zhang H. Amputation and limb salvage following endovascular and open surgery for the treatment of peripheral artery illnesses: A meta-analysis. Int Wound J 2023; 20:3558-3566. [PMID: 37328950 PMCID: PMC10588360 DOI: 10.1111/iwj.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 06/18/2023] Open
Abstract
A meta-analysis investigation was executed to measure the outcome of endovascular surgery (ES) and open surgery (OS) for the management of peripheral artery diseases (PADs) on amputation and limb salvage (LS). A comprehensive literature inspection till February 2023 was applied and 3451 interrelated investigations were reviewed. The 31 chosen investigations enclosed 19 948 individuals with PADs were in the chosen investigations' starting point, 8861 of them were utilising ES, and 11 087 were utilising OS. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of ES and OS for the management of PADs on amputation and LS by the dichotomous approaches and a fixed or random model. ES had significantly lower amputation (OR, 0.80; 95% CI, 0.68-0.93, P = 0.005) compared with those with OS in individuals with PADs. No significant difference was found between ES and OS in 30-day LS (OR, 0.95; 95% CI, 0.64-1.42, P = 0.81), 1-year LS (OR, 1.06; 95% CI, 0.81-1.39, P = 0.68), and 3-year LS (OR, 0.86; 95% CI, 0.61-1.19, P = 0.36) in individuals with PADs. ES had significantly lower amputation, 30-day LS, 1-year LS, and 3-year LS compared with those with OS in individuals with PADs. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Guohua Wang
- Department of General Surgery IIXinxiang Central HospitalXinxiangChina
| | - Huipeng Li
- Department of General Surgery IIXinxiang Central HospitalXinxiangChina
| | - Baoxing Chen
- Department of General Surgery IIXinxiang Central HospitalXinxiangChina
| | - Pengwei Guo
- Department of General Surgery IIXinxiang Central HospitalXinxiangChina
| | - Hua Zhang
- Department of General Surgery IIXinxiang Central HospitalXinxiangChina
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Farag N, Pham BL, Aldilli L, Bourque ML, Zigui M, Nauche B, Ades M, Drudi LM. A Systematic Review and Meta-Analysis on Sex-Based Disparities in Patients with Chronic Limb Threatening Ischemia Undergoing Revascularization. Ann Vasc Surg 2023; 95:317-329. [PMID: 37075836 DOI: 10.1016/j.avsg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis sought to describe the prognostic implications of sex on the clinical outcomes of patients undergoing interventions for chronic limb threatening ischemia (CLTI). METHODS Studies were systematically searched across 7 databases from inception to August 25, 2021 and rerun on October 11, 2022. Studies focusing on patients with CLTI undergoing open surgery, endovascular treatment (EVT), or hybrid procedures were included if sex-based differences were associated with a clinical outcome. Two independent reviewers screened studies for inclusion, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Primary outcomes included inpatient mortality, major adverse limb events (MALE), and amputation-free survival (AFS). Meta-analyses were performed using random effects models and reported pooled odds ratio (pOR) and 95% confidence interval (CI). RESULTS A total of 57 studies were included in the analysis. A meta-analysis of 6 studies demonstrated that female sex was associated with statistically higher inpatient mortality compared to male sex undergoing open surgery or EVT (pOR, 1.17; 95% CI: 1.11-1.23). Female sex also demonstrated a trend toward increased limb loss in those undergoing EVT (pOR, 1.15; 95% CI: 0.91-1.45) and open surgery (pOR 1.46; 95% CI: 0.84-2.55). Female sex also had a trend toward higher MALE (pOR, 1.06; 95% CI, 0.92-1.21) in 6 studies. Finally, female sex had a trend toward worse AFS (pOR, 0.85; 95% CI, 0.70-1.03) in 8 studies. CONCLUSIONS Female sex was significantly associated with higher inpatient mortality and a trend toward higher MALE following revascularization. Female sex trended toward worse AFS. The reasons for these disparities are likely multifaceted on patient, provider, and systemic levels and should be explored to identify solutions for decreasing these health inequities across this vulnerable patient population.
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Affiliation(s)
- Nardin Farag
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Bao Linh Pham
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lyne Aldilli
- Sciences biologiques, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Marie-Lyne Bourque
- Division of Vascular Surgery, Université de Montréal, Montreal, QC, Canada
| | - Marguerite Zigui
- École de Santé publique, Université de Montréal, Montreal, QC, Canada
| | - Benedicte Nauche
- Bibliothèque du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Matthew Ades
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, QC, Canada
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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Lou V, Dossabhoy SS, Tran K, Yawary F, Ross EG, Stern JR, Dalman RL, Chandra V. Validity of the Global Vascular Guidelines in Predicting Outcomes Based on First-Time Revascularization Strategy. Ann Vasc Surg 2023; 95:142-153. [PMID: 36828135 DOI: 10.1016/j.avsg.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The Global Vascular Guidelines (GVG) recommend selecting an endovascular versus open-surgical approach to revascularization for chronic limb-threatening ischemia (CLTI), based on the Global Limb Anatomic Staging System (GLASS) and wound, ischemia, and foot infection (WIfI) classification systems. We assessed the utility of GVG-recommended strategies in predicting clinical outcomes. METHODS We conducted a single-center, retrospective review of first-time lower-extremity revascularizations within a comprehensive limb-preservation program from 2010 to 2018. Procedures were stratified by (1) treatment concordance with GVG-recommended strategy (concordant versus nonconcordant groups), (2) GLASS stages I-III, and (3) endovascular versus open strategies. The primary outcome was 5-year freedom from major adverse limb events (FF-MALE), defined as freedom from reintervention or major amputation, and secondary outcomes included 5-year overall survival, freedom from major amputation, freedom from reintervention, and immediate technical failure (ITF) during initial revascularization. Kaplan-Meier (KM) survival analysis and multivariate analysis with Cox proportional hazard models were performed on the primary and secondary outcomes. RESULTS Of 281 first-time revascularizations for CLTI, 251 (89.3%) were endovascular and 186 (66.2%) were in the concordant group, with a mean clinical follow-up of 3.02 ± 2.40 years. Within the concordant group alone, 167 (89.8%) of revascularizations were endovascular. The concordant group had a higher rate of chronic kidney disease (60.8% vs. 45.3%, P = 0.02), WIfI foot infection grade (0.81 ± 1.1 vs. 0.56 ± 0.80, P = 0.03), and WIfI stage (3.1 ± 0.79 vs. 2.8 ± 1.2, P < 0.01) compared to the non-concordant group. After both KM and multivariate analyses, there were no significant differences in 5-year FF-MALE or overall survival between concordant and non-concordant groups. There was higher freedom from major amputation in the non-concordant group on KM analysis (83.9% vs. 74.2%, P = 0.025), though this difference was non-significant on multivariate analysis (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.21-1.15, P = 0.10). The open group had lower MALE compared to the endovascular group (HR: 0.39, 95% CI: 0.17-0.91, P = 0.029) attributed to a lower reintervention rate in the open group (HR: 0.31, 95% CI: 0.11-0.87, P = 0.026). GLASS stage was not associated with significant differences in outcomes, but the severity of GLASS stage was associated with ITF (2.1% in stage 1, 6.4% in stage 2, and 11.7% in stage 3, P = 0.01). CONCLUSIONS In this study, CLTI treatment outcomes did not differ significantly based on whether treatment was received in concordance with GVG-recommended strategy. There was no difference in overall survival between the endovascular and open groups, though there was a higher reintervention rate in the endovascular group. The GVG guidelines are an important resource to help guide the management of CLTI patients. However, in this study, both concordance with GVG guidelines and GLASS staging were found to be indeterminate in differentiating outcomes between complex CLTI patients treated primarily with an endovascular-first approach. The revascularization approach for a CLTI patient is a nuanced decision that must take into account patient anatomy and clinical status, as well as physician skill and experience and institutional resources.
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Affiliation(s)
- Vivian Lou
- Stanford University School of Medicine, Stanford, CA
| | - Shernaz S Dossabhoy
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Kenneth Tran
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Farishta Yawary
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Elsie G Ross
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Jordan R Stern
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Ronald L Dalman
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA
| | - Venita Chandra
- Stanford Health Care, Division of Vascular & Endovascular Surgery, Stanford, CA.
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Kobayashi T, Hamamoto M, Okazaki T, Tomota M, Fujiwara T, Yoshitomi Y, Hasegawa M, Takahashi S. Outcomes of a bypass-first strategy in chronic limb-threatening ischemia based on the Global Vascular Guidelines. J Vasc Surg 2023; 77:201-207. [PMID: 35934216 DOI: 10.1016/j.jvs.2022.06.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Global Vascular Guidelines (GVGs) recommend initial revascularization (bypass or endovascular therapy) for chronic limb-threatening ischemia (CLTI) based on anatomical complexity and limb severity. This decision is made based on a prediction of the outcomes after endovascular intervention. This study was performed to evaluate outcomes after distal bypass in cases recommended for GVG bypass. METHODS A total of 239 distal bypasses for CLTI were evaluated in 195 patients with a GVG bypass recommendation treated between 2009 and 2020 at a single center in Japan. Comparisons were made between crural and pedal bypass cases. RESULTS The 195 patients (median age, 77 years; 67% male) underwent 133 crural bypasses (106 patients; 54%) and 106 pedal bypasses (89 patients; 46%). Hemodialysis was more common in pedal cases than in crural cases (P = .03). Hospital deaths occurred in two cases (1%) within 30 days. The whole cohort has a follow-up rate of 96% over a mean of 28 ± 26 months, with 3-year limb salvage rates of 87% and 3-year primary, assisted primary, and secondary patency rates of 40%, 65%, and 67%, all without significant differences between crural and pedal cases. The 1-year wound healing rate was 88% and tended to be higher in crural cases than in pedal cases (P = .068). The 3-year survival rate was 52% in the cohort and did not differ significantly between crural and pedal cases. CONCLUSIONS Patients with CLTI with a GVG bypass recommendation had acceptable limb salvage, graft patency, wound healing, and survival after distal bypass, regardless of the bypass method. These findings indicate that a GVG bypass recommendation as an initial revascularization method is valid in the real world.
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Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Masaki Hamamoto
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Mayu Tomota
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takashi Fujiwara
- Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yuki Yoshitomi
- Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Misa Hasegawa
- Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan
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Rossi FH, Giusti JCG, Cury MVM, Beraldo JPN, Brochado Neto FC, Kambara AM. Real-life outcomes of endovascular and bypass infrapopliteal intervention for chronic limb-threatening ischemia in GLASS stages II and III. Eur J Vasc Endovasc Surg 2022; 64:41-48. [DOI: 10.1016/j.ejvs.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
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Shirasu T, Takagi H, Gregg A, Kuno T, Yasuhara J, Kent KC, Clouse WD. Predictability of the Global Limb Anatomic Staging System (GLASS) for technical and limb-related outcomes: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2022; 64:32-40. [DOI: 10.1016/j.ejvs.2022.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/09/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
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Sun Y, Zhou X, Zhang J. Bypass surgery versus endovascular intervention for lower extremity revascularization in patients with chronic renal disease or end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 2021; 54:589-600. [PMID: 34235596 DOI: 10.1007/s11255-021-02940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endovascular revascularization (ER) and open revascularization (OR) are recognized treatment modalities for peripheral artery disease, but whether one technique provides better outcomes than the other is unclear, especially in patients with chronic or end-stage renal disease. METHODS We conducted a systematic literature search on the PubMed, Scopus, and Google scholar databases. We considered randomized-controlled trials, and retrospective record-based and prospective studies for inclusion. All included studies compared patient outcomes between the two management modalities and reported adjusted effect sizes. RESULTS We found the risks of in-hospital mortality (OR 0.52; 95% CI 0.30-0.92) and 30-day mortality (OR 0.63; 95% CI 0.49-0.80) during the post-operative period to be significantly lower in patients undergoing ER than in those undergoing OR. The pooled odds of amputation within 30 days of the post-operative period suggested a significantly higher risk of amputation in patients undergoing ER (OR 1.51; 95% CI 1.32-1.73) than in the others. Compared to patients undergoing OR, those undergoing ER had higher odds of being discharged to home (OR 2.30; 95% CI 1.58-3.36), lower odds of wound complications within 24 months of the post-operative period (OR 0.34; 95% CI 0.15-0.79), and a reduced length of hospital stay (WMD - 5.9; 95% CI - 10.8 to - 1.00). CONCLUSIONS For elderly patients with ESRD and chronic limb ischemia, ER may be the best choice due to its lower risk of mortality, lower odds of wound complications, reduced length of hospital stay, and reduced risk of re-intervention requirement when compared to OR. However, OR should be considered as an option when limb salvage is preferred.
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Affiliation(s)
- Yan Sun
- Department of Vascular Surgery, Weifang People's Hospital, 151 Guangwen Street, Weifang, 261041, Shandong Province, People's Republic of China
| | - Xiaojing Zhou
- Department of Hepatobiliary Surgery, Weifang People's Hospital, Weifang, 261041, Shandong Province, People's Republic of China
| | - Jinmei Zhang
- Department of Hepatobiliary Surgery, Weifang People's Hospital, Weifang, 261041, Shandong Province, People's Republic of China.
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