REVIEW
Meta-analysis of the Clinical Effectiveness of Venous Arterialization for Salvage of Critically Ischaemic Limbs

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Abstract

Objective

The aim of this study is to assess the clinical effectiveness of venous arterialization in patients with critical limb ischaemia not reconstructable by conventional bypass.

Design

Meta-analysis of observational studies.

Materials

Eligible studies concerning treatment by venous arterialization for chronic critical leg ischaemia were identified from electronic database, cross-reference search and pertinent articles. There was no language restriction.

Methods

All relevant studies were systematically reviewed and data extracted by two independent reviewers. Study endpoints were foot preservation, secondary graft patency, postoperative clinical improvement and complications.

Results

A total of 56 studies were selected for comprehensive review. No RCTs were identified. Seven patient series, comprising 228 patients, matched the selection criteria. Overall 1-year foot preservation was 71% (95% CI: 64–77%) and 1-year secondary patency was 46% (95% CI: 39–53%). The large majority of patients in whom major amputation was avoided experienced successful wound healing, disappearance of rest pain and absence of serious complications.

Conclusion

On the basis of limited evidence, venous arterialization may be considered as a viable alternative before major amputation is undertaken in patients with ‘inoperable’ chronic critical leg ischaemia.

Keywords

Limb salvage
Lower extremity
Leg ulcer
Arteriovenous shunt
Review

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