PMID- 32439522 OWN - NLM STAT- MEDLINE DCOM- 20201124 LR - 20201124 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 68 DP - 2020 Oct TI - Clinical Effectiveness and Resource Utilization of Surgery versus Endovascular Therapy for Chronic Limb-Threatening Ischemia. PG - 510-521 LID - S0890-5096(20)30380-0 [pii] LID - 10.1016/j.avsg.2020.04.043 [doi] AB - BACKGROUND: The clinical effectiveness of surgical versus endovascular therapy for chronic limb-threatening ischemia (CLTI) continues to be debated, and the resources required for each therapy are unclear. METHODS: Systematic review of randomized controlled trials (RCTs) and observational studies comparing surgery with endovascular therapy for CLTI, which reported clinical effectiveness and resource utilization. Short-term and long-term clinical outcomes were examined. RESULTS: The search yielded 4,231 titles, of which 17 publications met our inclusion criteria. Five publications were all from 1 RCT, and 12 publications were observational studies. In the RCT, the surgical approach had greater resource use in the first year (total hospital days across all admissions for surgery versus angioplasty: 46.14 +/- 53.87 vs. 36.35 +/- 51.39; P < 0.001; also true for days in high-dependency and intensive therapy units), but differences were not statistically significant in subsequent years. All-cause mortality presented a nonsignificant difference favoring angioplasty in the first 2 years (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [95% CI], 0.75-2.15), but after 2 years, it favored surgical treatment (aHR, 0.34; 95% CI, 0.17-0.71). The observational studies reported short-term effectiveness and resource utilization favoring endovascular therapy, but most differences were not statistically significant. Long-term outcomes were more mixed; in particular, mortality outcomes generally favored surgery, although concluding that cause and effect is not possible as endovascularly treated patients tended to be older and may have had a shorter life expectancy regardless of therapy. CONCLUSIONS: The clinical effectiveness and resource utilization of surgery compared with endovascular therapy for CLTI is not known with certainty and will not be known until ongoing trials report results. It is likely that findings will vary by the time horizon, where initial outcomes and utilization tend to favor endovascular interventions, but long-term outcomes favor surgical revascularization. CI - Published by Elsevier Inc. FAU - Lamaina, Margherita AU - Lamaina M AD - Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. FAU - Childers, Christopher P AU - Childers CP AD - Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. FAU - Liu, Charles AU - Liu C AD - Department of Surgery, Stanford University, Stanford, CA; David Geffen School of Medicine, National Clinician Scholars Program, University of California Los Angeles, Los Angeles, CA; Department of Surgery, Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA. FAU - Mak, Selene S AU - Mak SS AD - Department of Surgery, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA. FAU - Booth, Marika S AU - Booth MS AD - RAND Corporation, Santa Monica, CA. FAU - Conte, Michael S AU - Conte MS AD - Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, CA. FAU - Maggard-Gibbons, Melinda AU - Maggard-Gibbons M AD - Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: MMaggard@mednet.ucla.edu. FAU - Shekelle, Paul G AU - Shekelle PG AD - Department of Surgery, Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA. LA - eng PT - Journal Article PT - Systematic Review DEP - 20200519 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Aged MH - *Angioplasty/adverse effects/mortality MH - Chronic Disease MH - Female MH - *Health Resources MH - Humans MH - Ischemia/diagnostic imaging/mortality/physiopathology/*therapy MH - Length of Stay MH - Male MH - Peripheral Arterial Disease/diagnostic imaging/mortality/physiopathology/*therapy MH - Randomized Controlled Trials as Topic MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Vascular Surgical Procedures/adverse effects/mortality EDAT- 2020/05/23 06:00 MHDA- 2020/11/25 06:00 CRDT- 2020/05/23 06:00 PHST- 2020/03/26 00:00 [received] PHST- 2020/04/29 00:00 [revised] PHST- 2020/04/30 00:00 [accepted] PHST- 2020/05/23 06:00 [pubmed] PHST- 2020/11/25 06:00 [medline] PHST- 2020/05/23 06:00 [entrez] AID - S0890-5096(20)30380-0 [pii] AID - 10.1016/j.avsg.2020.04.043 [doi] PST - ppublish SO - Ann Vasc Surg. 2020 Oct;68:510-521. doi: 10.1016/j.avsg.2020.04.043. Epub 2020 May 19.