A Systematic Review and Meta-Analysis of Treatment Options for Chronic Limb Threatening Ischemia: A Direct Assessment

Abstract

Objectives: Chronic Limb Threatening Ischemia (CLTI) is a progressive form of Peripheral Artery Disease (PAD) that poses a significant risk of limb amputation and mortality. Treatment options include bypass surgery and endovascular therapy, both of which come with their own risks. Our study aims to compare outcomes of these interventions, offering insights for informed decision-making in managing chronic limb-threatening ischemia. Methodology: This meta-analysis included adult patients and utilized data exclusively from English language Randomized Controlled Trials searched from PubMed and Cochrane databases from database inception to July 12, 2023. The reporting bias was assessed using RoB 2.0 software by the Cochrane Collaboration. Results: A total of 8 studies, comprising 4,399 patients, were included in this review. The primary outcomes focused on wound infection and myocardial infarction in Chronic Limb-threatening Ischemia (CLTI) patients undergoing either Bypass Surgery (n=2,155) or Endovascular Therapy (n=2,244). Secondary outcomes were re-stenosis and hematoma. A total of 386 (17.9%) complications were reported among patients receiving bypass surgery and 328 (14.6%) complications among patients receiving endovascular therapy. Patients undergoing endovascular surgery reported a significantly lower rate of wound infections (11.2%) in comparison to patients undergoing bypass surgery (18%). Conclusion: There is a reduced risk of complications in patients undergoing endovascular therapy for chronic limb threatening ischemia (CLTI) as compared to those undergoing bypass surgery. Endovascular therapy significantly reduces wound infection risk compared to bypass surgery. Evidence on myocardial infarction, restenosis, and hematoma lacks significant differences. Sensitivity analyses suggest further investigation is needed, emphasizing the importance of larger, well-designed studies with longer follow-ups.