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

Abstract

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.