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Bypass surgery versus endovascular intervention for lower extremity revascularization in patients with chronic renal disease or end-stage renal disease: a systematic review and meta-analysis

  • Nephrology - Review
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Abstract

Background

Endovascular revascularization (ER) and open revascularization (OR) are recognized treatment modalities for peripheral artery disease, but whether one technique provides better outcomes than the other is unclear, especially in patients with chronic or end-stage renal disease.

Methods

We conducted a systematic literature search on the PubMed, Scopus, and Google scholar databases. We considered randomized-controlled trials, and retrospective record-based and prospective studies for inclusion. All included studies compared patient outcomes between the two management modalities and reported adjusted effect sizes.

Results

We found the risks of in-hospital mortality (OR 0.52; 95% CI 0.30–0.92) and 30-day mortality (OR 0.63; 95% CI 0.49–0.80) during the post-operative period to be significantly lower in patients undergoing ER than in those undergoing OR. The pooled odds of amputation within 30 days of the post-operative period suggested a significantly higher risk of amputation in patients undergoing ER (OR 1.51; 95% CI 1.32–1.73) than in the others. Compared to patients undergoing OR, those undergoing ER had higher odds of being discharged to home (OR 2.30; 95% CI 1.58–3.36), lower odds of wound complications within 24 months of the post-operative period (OR 0.34; 95% CI 0.15–0.79), and a reduced length of hospital stay (WMD − 5.9; 95% CI − 10.8 to − 1.00).

Conclusions

For elderly patients with ESRD and chronic limb ischemia, ER may be the best choice due to its lower risk of mortality, lower odds of wound complications, reduced length of hospital stay, and reduced risk of re-intervention requirement when compared to OR. However, OR should be considered as an option when limb salvage is preferred.

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Authors and Affiliations

  1. Department of Vascular Surgery, Weifang People’s Hospital, 151 Guangwen Street, Weifang, 261041, Shandong Province, People’s Republic of China

    Yan Sun

  2. Department of Hepatobiliary Surgery, Weifang People’s Hospital, Weifang, 261041, Shandong Province, People’s Republic of China

    Xiaojing Zhou & Jinmei Zhang

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  1. Yan Sun
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Correspondence to Jinmei Zhang.

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Sun, Y., Zhou, X. & Zhang, J. Bypass surgery versus endovascular intervention for lower extremity revascularization in patients with chronic renal disease or end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 54, 589–600 (2022). https://doi.org/10.1007/s11255-021-02940-5

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