Comparison of Bypass Surgery versus Endovascular Interventions for Peripheral Artery Disease through Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of bypass surgery with those of endovascular interventions for the treatment of peripheral artery disease.

MATERIALS AND

METHODS

PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov were searched until July 2023 for RCTs comparing bypass surgery and endovascular interventions in patients with intermittent claudication or critical limb-threatening ischemia. Primary outcomes included technical success, 30-day morbidity and mortality, 1-year primary patency, and major amputation at 1 year. A random-effects model was employed for pooling odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses and meta-regression were used to explore heterogeneity.

RESULTS

Fourteen RCTs involving 3,856 patients were included. Bypass surgery achieved significantly higher technical success (OR, 8.50; 95% CI, 5.46-13.25) and 1-year primary patency (OR, 1.43; 95% CI, 1.03-1.99), However, it was associated with increased 30-day morbidity (OR, 1.38; 95% CI, 1.03-1.86), 30-day mortality (OR, 1.87; 95% CI, 1.10-3.18), and 1-year major amputation rates (OR, 2.58; 95% CI, 1.13-5.88) compared with endovascular interventions. Differences in 1-year amputation-free survival, primary assisted and secondary patency at 1 year, reintervention rates within 1 year, 30-day major adverse cardiac events, postprocedural change in the ankle-brachial index, and changes in health-related quality of life at 1 year, 1-year clinical improvement, and 1-year all-cause mortality were statistically nonsignificant.

CONCLUSIONS

Bypass surgery resulted in higher technical success and 1-year primary patency; however, endovascular interventions resulted in lower initial morbidity and mortality and major amputations.