A Systematic Review and Meta-Analysis of Endovascular Angiosomal Revascularization in the Setting of Collateral Vessels. [Review]

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: Both DR and IRc offer significantly improved wound healing rates and major amputation rates compared to IR when utilized to treat critical limb ischemia. Although DR should be the preferred method of revascularization, IRc can offer comparable outcomes when DR is not possible. Analysis was limited by small sample size of IRc limbs, a predominance of retrospective studies, and variability in outcome definitions between studies. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: A meta-analysis was performed in accordance with PRISMA guidelines. Ovid MEDLINE was queried for records pertaining to the study question using appropriate Medical Subject Heading (MeSH) terms. Studies were limited to those using DR, IR, or IRc as a primary intervention and reporting information on at least one of the primary outcomes of interest. No limitation was placed on year of publication, country of origin or study size. Studies were assessed for validity using the Newcastle-Ottawa Scale. Study characteristics and patient demographics were collected. Data representing the primary outcomes - wound healing, major amputation, reintervention, and all-cause mortality - were collected for time points ranging from one month to four years following intervention. Meta-analysis on sample size-weighted data assuming a random-effects model was performed to calculate odds ratios for the four primary outcomes at various time points.

OBJECTIVES: Endovascular procedures for targeted treatment of lower extremity wounds can be subdivided as direct (DR), indirect (IR), and indirect revascularization via collateral flow (IRc). While previous systematic reviews assert superiority of DR when compared to IR, the role of collateral vessels in clinical outcomes remains to be defined. This systematic review and meta-analysis aims to define the utility of DR, IR, and IRc in treatment of lower extremity wounds with respect to 1) wound healing, 2) major amputation 3) reintervention and 4) all-cause mortality.

RESULTS: 21 studies were identified for a total of 4252 limbs(DR 2231, IR 1647, IRC 270). Overall wound healing rates were significantly superior for DR(OR=2.45; p=0.001) and IRc(OR=8.46; p<0.00001) compared to IR with no significant difference between DR and IRc(OR=1.25; p=0.23). Overall major amputation rates were significantly superior for DR(OR=0.48; p<0.00001) and IRc(OR=0.44; p=0.006) compared to IR, with DR exhibiting significantly improved rates compared to IRc(OR=0.51; p=0.01). Overall mortality rates showed no significant differences between DR(OR=0.89; p=0.37) and IRc(OR=1.12; p=0.78) compared to IR, with no significant difference between DR and IRc(OR=0.54; p=0.18). Overall reintervention rates showed no significant difference between DR and IR(OR=1.05; p=0.81), with no studies reporting reintervention outcomes for IRc.

English