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Similar Patency and Limb Salvage Rates in Comparing Primary Bypass with Bypass Following Failed Endovascular Intervention for Lower Limb Arterial Occlusive Disease
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Abstracts
Journal of Vascular Surgery September 2017
Similar Patency and Limb Salvage Rates in Comparing Primary Bypass with Bypass Following Failed Endovascular Intervention for Lower Limb Arterial Occlusive Disease Sajjid Hossain, MD, Dominic Leblanc, Adam Power, MD, Guy DeRose, MD, Audra Duncan, MD, Luc Dubois, MD, MSc. Division of Vascular Surgery, Western University, London, Ontario Objective: Patients with infrainguinal peripheral arterial disease often undergo multiple revascularization procedures. Although many centers have adopted an endovascular-first approach, some are reluctant for fear of damaging outflow and compromising the outcomes of any subsequent bypasses. Methods: A systematic review was conducted of MEDLINE, Embase, and CENTRAL databases for studies that compared outcomes of primary infrainguinal bypass with bypass after failed endovascular intervention for peripheral arterial disease. Abstracts
Results: There were 2112 abstracts screened, with 43 selected for fulltext review. Of these, 13 studies involving 7325 patients met the inclusion criteria. Pooling the results of studies comparing primary bypass with bypass after failed endovascular intervention showed no significant difference in primary patency (OR, 1.37; 95% CI, 0.61-3.08; Fig 1) or ipsilateral limb salvage at 1 year (OR, 1.37; 95% CI, 0.57-3.28). Similarly, 30-day amputation rates (OR, 1.75; 95% CI, 0.55-5.59), 30-day mortality (OR, 1.04; 95% CI, 0.67-1.61), and 1-year secondary patency (OR, 0.94; 95% CI, 0.47-1.88) were similar between groups. There was a trend toward higher rates of early graft occlusion (OR, 4.24; 95% CI, 0.81-22.09) and worse 3-year amputation-free survival (OR, 1.52; 95% CI, 0.94-2.45) for patients who failed to respond to endovascular intervention, but this was nonsignificant (Fig 2). Conclusions: Meta-analysis of the existing literature comparing primary bypass with bypass following endovascular intervention shows no significant difference in patency or limb salvage. The existing published data are limited by observational study design, inconsistent patient selection, and significant heterogeneity yet suggest that bypass
Fig 1. Forrest plot comparing the odds ratio (OR [95% confidence interval (CI)]) for primary patency at 1 year between primary bypass and bypass after failed endovascular intervention (OR >1 indicates higher patency rate in primary bypass group).
Fig 2. Forrest plot comparing the pooled odds ratio (OR [95% confidence interval (CI)] for (A) early graft occlusion (within 30 days; OR >1 indicates higher rates of graft occlusion in the bypass after failed endovascular intervention group) and (B) amputation-free survival at 3 years (OR >1 indicates higher amputation-free survival in the primary bypass group).
and full-text studies were screened independently by two reviewers with data abstraction done in duplicate. Dichotomous outcome measures were reported using the odds ratio (OR) and 95% confidence interval (CI) and pooled using random-effects models. Study quality was assessed using the Newcastle Ottawa Scale.
following failed endovascular intervention does not conclusively result in inferior outcomes. Author Disclosures: S. Hossain: Nothing to disclose; D. LeBlanc: Nothing to disclose; A. Power: Nothing to disclose; G. DeRose: Nothing to disclose; A. Duncan: Nothing to disclose; L. Dubois: Nothing to disclose.
Abstracts
Journal of Vascular Surgery September 2017
Similar Patency and Limb Salvage Rates in Comparing Primary Bypass with Bypass Following Failed Endovascular Intervention for Lower Limb Arterial Occlusive Disease Sajjid Hossain, MD, Dominic Leblanc, Adam Power, MD, Guy DeRose, MD, Audra Duncan, MD, Luc Dubois, MD, MSc. Division of Vascular Surgery, Western University, London, Ontario Objective: Patients with infrainguinal peripheral arterial disease often undergo multiple revascularization procedures. Although many centers have adopted an endovascular-first approach, some are reluctant for fear of damaging outflow and compromising the outcomes of any subsequent bypasses. Methods: A systematic review was conducted of MEDLINE, Embase, and CENTRAL databases for studies that compared outcomes of primary infrainguinal bypass with bypass after failed endovascular intervention for peripheral arterial disease. Abstracts
Results: There were 2112 abstracts screened, with 43 selected for fulltext review. Of these, 13 studies involving 7325 patients met the inclusion criteria. Pooling the results of studies comparing primary bypass with bypass after failed endovascular intervention showed no significant difference in primary patency (OR, 1.37; 95% CI, 0.61-3.08; Fig 1) or ipsilateral limb salvage at 1 year (OR, 1.37; 95% CI, 0.57-3.28). Similarly, 30-day amputation rates (OR, 1.75; 95% CI, 0.55-5.59), 30-day mortality (OR, 1.04; 95% CI, 0.67-1.61), and 1-year secondary patency (OR, 0.94; 95% CI, 0.47-1.88) were similar between groups. There was a trend toward higher rates of early graft occlusion (OR, 4.24; 95% CI, 0.81-22.09) and worse 3-year amputation-free survival (OR, 1.52; 95% CI, 0.94-2.45) for patients who failed to respond to endovascular intervention, but this was nonsignificant (Fig 2). Conclusions: Meta-analysis of the existing literature comparing primary bypass with bypass following endovascular intervention shows no significant difference in patency or limb salvage. The existing published data are limited by observational study design, inconsistent patient selection, and significant heterogeneity yet suggest that bypass
Fig 1. Forrest plot comparing the odds ratio (OR [95% confidence interval (CI)]) for primary patency at 1 year between primary bypass and bypass after failed endovascular intervention (OR >1 indicates higher patency rate in primary bypass group).
Fig 2. Forrest plot comparing the pooled odds ratio (OR [95% confidence interval (CI)] for (A) early graft occlusion (within 30 days; OR >1 indicates higher rates of graft occlusion in the bypass after failed endovascular intervention group) and (B) amputation-free survival at 3 years (OR >1 indicates higher amputation-free survival in the primary bypass group).
and full-text studies were screened independently by two reviewers with data abstraction done in duplicate. Dichotomous outcome measures were reported using the odds ratio (OR) and 95% confidence interval (CI) and pooled using random-effects models. Study quality was assessed using the Newcastle Ottawa Scale.
following failed endovascular intervention does not conclusively result in inferior outcomes. Author Disclosures: S. Hossain: Nothing to disclose; D. LeBlanc: Nothing to disclose; A. Power: Nothing to disclose; G. DeRose: Nothing to disclose; A. Duncan: Nothing to disclose; L. Dubois: Nothing to disclose.