Endovascular revascularization vs open bypass surgery for patients with chronic limb-threatening ischemia: A systematic review and meta-analysis of randomized controlled trials
Bibliographic record
Abstract
Background Chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral artery disease and the best revascularization strategy remains debated, especially for this specific patient population. This meta-analysis aimed to compare the outcomes of endovascular revascularization (ER) and open surgical bypass in treating CLTI to determine which treatment is more effective in terms of limb salvage. Methods A systematic review and meta-analysis was conducted on Medline, Embase, and Cochrane Central Register of Controlled Trials to identify randomized controlled trials comparing infrainguinal bypass surgery and ERs in adults with CLTI. The studies were appraised using the Risk of Bias 2 tool and all statistical analyses were performed in RevMan Web using a random effect model. Dichotomous data results were presented as risk ratios (RR) with 95% confidence intervals (CI). The primary outcome was amputation-free survival (AFS) and secondary outcomes included major adverse limb events (MALEs), all-cause mortality, major adverse cardiovascular events (MACEs), and overall patency. Subgroup analyses for the primary outcome were performed according to age, risk of bias, and severity of the disease (rest pain and/or tissue loss) to assess the impact on outcomes and explore heterogeneity sources. The quality of evidence was assessed using the GRADE approach. Results This systematic review identified six randomized controlled trials (n = 2760 patients). Findings indicated no significant difference in AFS between open bypass surgery (OBS) and ER (44.2% vs 52.5%; RR, 0.90; 95% CI, 0.72-1.11; P = .33) for a median follow-up of 36 months (range, 17.4-46.5 months). OBS was associated with a lower incidence of MALEs (22.4% vs 36.1%; RR, 0.65; 95% CI, 0.48-0.88; P = .005). There was no significant difference in all-cause mortality (35.6% vs 35.9%; RR,1.04; 95% CI, 0.88-1.23; P = .64) or MACEs (45.0% vs 47.6%; RR, 0.98; 95% CI, 0.87-1.10; P = .70). Patency rates were similar in both groups (21.5% vs 41.5%; RR, 0.54; 95% CI, 0.27-1.06; P = .07). The GRADE quality of evidence was moderate. Conclusions This systematic review and meta-analysis did not reveal any significant difference in AFS, all-cause mortality, MACE, and patency between ER and open infrainguinal bypass surgery for CLTI. However, OBS was associated with a lower incidence of MALEs. The findings highlight the need for further high-quality research to refine and tailor treatment approaches for patients with CLTI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.042 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.024 | 0.042 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".