Below-the-Ankle Angioplasty in Patients with Critical Limb Ischemia: A Systematic Review and Meta-Analysis

Eline Huizing; Michiel A Schreve; Jean-Paul P M de Vries; Roberto Ferraresi; Steven Kum; Çağdaş Ünlü

doi:10.1016/j.jvir.2019.05.001

Below-the-Ankle Angioplasty in Patients with Critical Limb Ischemia: A Systematic Review and Meta-Analysis

J Vasc Interv Radiol. 2019 Sep;30(9):1361-1368.e2. doi: 10.1016/j.jvir.2019.05.001. Epub 2019 Jul 29.

Authors

Eline Huizing¹, Michiel A Schreve², Jean-Paul P M de Vries³, Roberto Ferraresi⁴, Steven Kum⁵, Çağdaş Ünlü²

Affiliations

¹ Department of Surgery, Northwest Clinics, Wilhelminalaan 12, Alkmaar 1815 JD, The Netherlands. Electronic address: e.huizing@nwz.nl.
² Department of Surgery, Northwest Clinics, Wilhelminalaan 12, Alkmaar 1815 JD, The Netherlands.
³ Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
⁴ Peripheral Interventional Unit, Humanitas Gavazzeni, Bergamo, Italy.
⁵ Department of Surgery, Vascular Service, Changi General Hospital, Singapore.

PMID: 31371138
DOI: 10.1016/j.jvir.2019.05.001

Abstract

Purpose: To evaluate the safety and effectiveness of below-the-ankle (BTA) angioplasty and to assess whether additional BTA angioplasty after below-the-knee (BTK) angioplasty would improve clinical outcomes in patients with critical limb ischemia.

Materials and methods: Two authors independently performed the search, study selection, assessment of methodological quality, and data extraction for this systematic review and meta-analysis. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Articles were eligible if it was reported that BTA angioplasty was performed and if the articles were published in English and had the full text available. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. The primary outcome was 12-month limb salvage rate. Secondary outcomes were 12-month amputation-free survival, technical success, complications, survival, and freedom from reintervention.

Results: Ten articles met the inclusion criteria, reporting a total of 478 patients with BTA angioplasty performed in 524 legs. Three of the 10 included studies compared BTK angioplasty only to BTK angioplasty and additional BTA angioplasty. The pooled 12-month limb salvage rate was 92% (95% confidence interval [CI], 0.88-0.96). No statistically significant difference was found in limb salvage when additional BTA angioplasty was compared to BTK angioplasty only (odds ratio [OR], 1.23; 95% CI, 0.61-2.49). The pooled 12-month amputation-free survival was 78% (95% CI, 0.69-0.87). No statistically significant difference was found in amputation-free survival rate when additional BTA angioplasty was compared to BTK angioplasty only (OR, 1.58; 95% CI, 0.95-2.64). The methodological quality of the studies included was moderate, according to the MINORS score.

Conclusions: This systematic review and meta-analysis showed that additional BTA angioplasty is a safe and feasible procedure, with a 92% pooled proportion of limb salvage at 12 months.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Amputation, Surgical
Angioplasty* / adverse effects
Ankle / blood supply*
Critical Illness
Female
Humans
Ischemia / diagnostic imaging
Ischemia / physiopathology
Ischemia / therapy*
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease / diagnostic imaging
Peripheral Arterial Disease / physiopathology
Peripheral Arterial Disease / therapy*
Progression-Free Survival
Regional Blood Flow
Retreatment
Risk Factors
Time Factors