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Bypass surgery for chronic lower limb ischaemiaFowkes F, Leng GC
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SummaryBypass surgery for chronic lower limb ischaemiaThere is not enough evidence to favour bypass surgery over angioplasty to treat chronic limb ischaemia (inadequate blood flow to the legs). The most common symptom of arterial disease of the leg is claudication, a cramping pain caused by an inadequate supply of blood to the affected muscle. It often affects the calf muscle and is typically triggered by exercise and relieved by rest. More severe restriction of the blood supply may produce pain at rest, leg ulcers or gangrene. These conditions, and severe claudication, may require bypass surgery or angioplasty (repair by minor surgery) to improve blood flow to the leg. The review of trials found no evidence to favour bypass surgery over angioplasty in terms of the effect on walking distance, complications and disease progression, amputation rate or death. There was evidence in patients with critical lower limb ischaemia that surgery was associated with increased surgical complications and longer hospital stays than for those that received angioplasty. There was also no clear evidence to favour bypass surgery compared with other treatments. Further research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 24. 2000 AbstractBackgroundSurgical bypass of an occluded arterial segment is one of the mainstay treatments for patients with critical limb ischaemia (CLI). However, it was introduced without formal evaluation. ObjectivesTo determine the effects of bypass surgery in patients with CLI. Search strategyThe Cochrane Peripheral Vascular Diseases (PVD) Group searched their trials register (last searched 26 November 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched Issue 4, 2007). We contacted principal trial investigators. Selection criteriaAll randomised controlled trials (RCTs) of bypass surgery versus control or any other treatment. Data collection and analysisFor the update one author and PVD editorial staff extracted data and assessed trial quality. Unpublished data were obtained from trial investigators. Data were analyzed using Peto odds ratio (OR) or weighted mean difference (fixed and random effects models). Main resultsNineteen trials were identified. Eight involved a total of just over 1200 patients. Four trials compared bypass surgery with angioplasty (PTA) and one each with thromboendarterectomy, thrombolysis, exercise, and spinal cord stimulation. Four included patients with intermittent claudication (IC) and CLI, two were restricted to claudicants, and two to CLI. Vein grafts were used for distal reconstructions and synthetic prostheses for aorto-iliac or ilio-femoral bypasses. Six trials included mortality. In general, trial quality was good; blinding was not possible. Mortality and amputation rates did not differ significantly between bypass surgery and PTA; primary patency was significantly higher in the bypass group after 12 months (Peto OR 1.6, 95% CI 1.0 to 2.6) but not after four years (P = 0.14). In patients with lower CLI, surgery was associated with increased surgical complications (Peto OR 2.69, 95% CI 1.87 to 3.86) and longer hospital stays during the first year, mean stay 46.1 days (SD 53.9) compared with 36.4 days (SD 51.4) for those receiving PTA (P < 0.0001). Amputation rates were significantly lower in bypass compared with thrombolysis (Peto OR 0.2, 95% CI 0.1 to 0.6); mortality rates did not differ. Blood flow restoration was significantly greater in bypass than in thromboendarterectomy patients (Peto OR 9.2, 95% CI 1.7 to 50.6); mortality and amputation rates did not differ. Bypass surgery outcomes did not differ significantly from exercise or spinal cord stimulation. Authors' conclusionsThere is limited evidence for the effectiveness of bypass surgery compared with other treatments; no studies compared bypass to no treatment. Further large trials are required. |