Abstract
Introduction: The purpose of this meta-analysis is to examine the current evidence and compare the clinical outcomes of endovascular therapy and surgical revascularization for the treatment of critical limb-threatening ischemia CLTI. Methods: We conducted a systematic search of electronic databases for studies comparing the outcomes of endovascular therapy versus surgery in patients with CLTI. The primary outcomes were major adverse limb events (MALE) and major adverse cardiovascular events (MACE), while secondary outcomes included risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and length of hospital stay. Results: A total of 14 observational studies (57,494 patients) were included. The overall effect favors surgery over endovascular intervention in terms of MALE [RR 1.13, 95 % CI (1.01-1.28), P = 0.04]. Endovascular therapy is associated with lower MACE rates compared to surgery [RR 0.62, 95 % CI (0.51-0.76), P < 0.00001]. Furthermore, the risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure as well as the length of hospital stay were lower with endovascular intervention. Conclusion: Surgery may be preferred for CLTI patients to endovascular therapy as it has reduced MALE risk. Endovascular treatment may reduce the incidence of MACE, bleeding, readmission, unplanned reoperation, acute renal failure, and the length of hospital stay. Novel endovascular techniques may enhance results, particularly for patients with severe illness or limited surgical choices. The treatment decision should be based on several factors like individual patient characteristics and anatomical considerations.
Published Version
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