Editor's Choice - Direct vs. Indirect Angiosomal Revascularisation of Infrapopliteal Arteries, an Updated Systematic Review and Meta-analysis

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
Nafi DilaverD C Bosanquet

Abstract

The importance of the angiosome concept in tibial artery revascularisation remains controversial. The aim of this review was to assess the outcomes of direct revascularisation (revascularisation to the angiosome of tissue loss; DR) versus indirect revascularisation (IR) in infrapopliteal arteries. A previously conducted systematic review was updated according to PRISMA guidelines. Studies comparing DR with IR by both endovascular and surgical means for patients with localised tissue loss were included. Meta-analyses were performed to assess the effect of DR versus IR on wound healing (total and time to healing), limb salvage, mortality, and re-intervention rates, with multiple sensitivity analyses. Outcome data quality was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Seven studies (2278 limbs) were identified in the updated search, which when combined with the previous search resulted in 22 studies, comprising 4146 limbs, being included. Wound healing rates (odds ratio [OR] 0.51; 95% CI 0.39-0.68, p < 0.001), time to wound healing (standard mean difference [SMD] -1.70; 95% CI -3.34 to -0.07, p = .04) and limb salvage (OR 0.37; 95% CI 0.24-0.58, p < .0001) were significantl...Continue Reading

Citations

Nov 12, 2019·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Vlad-Adrian AlexandrescuTommy Sinatra
Sep 1, 2020·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Gabriele TestiSimone Grotti
Sep 12, 2020·The International Journal of Lower Extremity Wounds·Roberto FerraresiRobert G Frykberg
Oct 23, 2019·Annals of Vascular Diseases·Yosuke HataToshiaki Mano
Jan 20, 2021·The Journal of Cardiovascular Surgery·Muzzafer A ChauderyHany Zayed
Nov 3, 2021·The British Journal of Dermatology·D C Bosanquet, K G Harding

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