Single-vessel versus multiple-vessel endovascular revascularization of infrapopliteal arteries in chronic limb-threatening ischemia patients: A systematic review and meta-analysis.

Abstract

Current practice guidelines offer no recommendation in terms of the number of infrapopliteal (IP) arteries to revascularize in patients with chronic limb-threatening ischemia (CLTI). This study aims to present the pooled quantitative evidence of single-vessel endovascular revascularization (SVER) vs multiple-vessel endovascular revascularization (MVER) of IP arteries in patients with CLTI. We performed a comprehensive systematic review and meta-analysis of all available studies reporting outcomes for SVER vs MVER of IP arteries in patients with CLTI, by searching the MEDLINE, Embase, and Cochrane Database. Pooled estimates were presented as odds ratios (ORs) for dichotomous data and hazard ratios (HRs) for time-to-event data using a random effect model. This study was registered with PROSPERO (No. CRD42021290764). Thirteen studies with a total of 4547 patients (2595 SVER; 1952 MVER) were included in this meta-analysis. Compared with SVER, MVER presented an equivalent risk to limb salvage (HR, 1.28; 95% CI, 0.83-1.96; P = .26) and overall survival (HR, 1.05; 95% CI, 0.72-1.55; P = .79), yet provided significantly better clinical outcomes of amputation-free survival (HR, 1.56; 95% CI, 1.08-2.25; P = .02) and complete ulcer healing (HR, 1.53; 95% CI, 1.05-2.21; P = .03). However, MVER were associated with more contrast material volume (weighted mean difference [WMD], -19.33; 95% CI, -28.64 to -10.03; P < .001) and more fluoroscopy time (WMD, -14.55; 95% CI, -28.06 to -1.05; P = .03). GRADE assessment revealed all results had a low or very low quality of evidence. MVER appeared to be associated with better amputation-free survival and complete ulcer healing, but not with better limb salvage and overall survival. MVER might represent a better choice for patients with CLTI; however, a comprehensive perioperative evaluation should be taken into consideration.