Short and Midterm Outcomes of Percutaneous Deep Venous Arterialisation for No Option Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis.

Autor: Tsukagoshi J; Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. Electronic address: https://twitter.com/tj_TeamWADA., Orrukem M; John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA., Shimamura J; Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Centre, Valhalla, NY, USA. Electronic address: https://twitter.com/ShimamuraMD., Secemsky EA; Division of Cardiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA. Electronic address: https://twitter.com/EricSecemskyMD., Nakama T; Department of Cardiology, Tokyo Bay Medical Centre, Urayasu, Japan. Electronic address: https://twitter.com/tatsuya_nakama., Yokoyama Y; Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: https://twitter.com/YujiroYokoyamaD., Takagi H; Department of Cardiovascular Surgery, Shizuoka Medical Centre, Shizuoka, Japan., Kuno T; Department of Cardiology, Montefiore Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Department of Cardiology, Jacobi Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: kuno-toshiki@hotmail.co.jp.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Aug 08. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1016/j.ejvs.2024.08.001
Abstrakt: Objective: Percutaneous deep venous arterialisation (pDVA) is a state of the art technique for treating patients with chronic limb threatening ischaemia (CLTI) with no conventional option for revascularisation. There are limited large scale data examining the clinical effectiveness of pDVA for patients with end stage CLTI.
Data Sources: MEDLINE, Embase, Google Scholar, and Cochrane databases.
Review Methods: Four databases were searched from January 2018 to June 2024 to identify studies investigating the feasibility and clinical outcomes of pDVA for patients with CLTI with no conventional revascularisation options. Meta-analysis of time to event outcomes (mean ± standard deviation) was performed for amputation free survival as the primary outcome, and freedom from amputation and overall survival as secondary outcomes. Other secondary outcomes (mean and 95% confidence interval [CI]) were procedural success rate, patency, re-intervention, and complete wound healing.
Results: Ten non-randomised studies were included with 351 patients. The mean patient age was 70.3 years, and 67.6% were male. Most procedures used the posterior tibial artery. The aggregated rate of amputation free survival at six and twelve months (five studies, 260 patients) was 72.6 ± 2.8% and 66.0 ± 3.1%, respectively, while the overall survival at six and twelve months (five studies, 260 patients) was 85.0 ± 2.3% and 77.7 ± 2.9%, respectively. The procedural success rate (nine studies, 330 patients) was 95.5% (95% CI 92.4 - 98.7%). Primary and secondary patency at six months (four studies, 241 patients) was 23.4% (95% CI 13.6 - 33.2%) and 54.9% (95% CI 34.3 - 75.5%), respectively. The rates of re-intervention (four studies, 190 patients) and complete wound healing (five studies, 190 patients) at twelve months were 41.7% (95% CI 25.7 - 57.7%) and 46.0% (95% CI 31.7 - 60.3%), respectively.
Conclusion: This meta-analysis demonstrated acceptable feasibility for no option CLTI at highly specialised institutions for patients undergoing pDVA. Meta-analysis of time to event outcomes revealed that pDVA provides reasonable amputation free survival for up to twelve months, albeit with a overall low certainty of evidence. Wider adoption of pDVA may be considered in selected patients with CLTI, although its clinical impact and cost effectiveness require further evaluation.
(Copyright © 2024 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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