Comparison between endovascular and open surgery for the treatment of peripheral artery diseases: a meta-analysis.

Abstract

The purpose of this study is to compare the efficacy and safety between endovascular surgery and open surgery for the treatment of peripheral artery disease (PAD). Studies were recruited from EMBASE, PubMed, Cochrane Library, and reviewing reference lists of related studies between June 2017 and 31 December 2018. Data of functional outcomes were extracted in this meta-analysis. Odds ratio (OR) or standardized mean differences (SMDs) with its 95% confidence interval (CI) were used. Pooled data proved to be absent of heterogeneity were tested by a fixed effects model; otherwise we used a random-effects model. All analyses were managed with RevMan 5.3 software. Twenty-seven trials (seven randomized controlled trials and twenty retrospective trials) involving a total of 17536 participants were included in our meta-analysis. Data showed that endovascular surgery was accompanied with lower complication rate (426/ 4496 (9.48%) vs. 551/4051 (13.60%):95%CI; 0.53 [0.34,0.82];I2 = 83%;P = 0.004) and shorter hospital stay (95%CI;-4.01[-4.99, -3.02];I2 = 76%; P<0.00001) than open surgery. Higher amputation (204/1633 (12.49%) vs. 228/1247 (18.28%):95%CI; 0.72 [0.59, 0.89];I2 = 12%;P = 0.002] and mortality during follow up [490/4514 (10.86%) vs. 341/4520 (7.54%): 95% CI; 0.73 [0.61, 0.86];I2 = 0%;P<0.05] were found in open surgery group. No evidence showed the rate of technical success, survival or limb salvage reduced in endovascular surgery. In conclusion, our results showed that endovascular surgery is a promising technique for the treatment of PAD. Our data showed that endovascular surgery has less complication, shorter hospital stay, lower amputation and mortality rate when compared to open surgery, although no significant difference was observed in survival rate, surgery success and limb salvage.