title: A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial disease.
abstract: BACKGROUND
  Controversy exists as to the relative merits of surgical and endovascular treatment of femoropoliteal arterial disease.
  
  
  METHODS
  A systematic review of the literature was undertaken to identify studies comparing open surgical and percutaneous transluminal methods for the treatment of femoropopliteal arterial disease. Outcome data were pooled and combined overall effect sizes were calculated using fixed or random effects models.
  
  
  RESULTS
  Four randomized controlled trials and six observational studies reporting on a total of 2817 patients (1387 open, 1430 endovascular) were included. Endovascular treatment was accompanied by lower 30-day morbidity (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.34-6.41) and higher technical failure (OR, 0.10; 95% CI, 0.05-0.22) than bypass surgery, whereas no differences in 30-day mortality between the two groups were identified (OR, 0.92; 95% CI, 0.55-1.51). Higher primary patency in the surgical treatment arm was found at 1 (OR, 2.42; 95% CI, 1.37-4.28), 2 (OR, 2.03; 95% CI, 1.20-3.45), and 3 (OR, 1.48; 95% CI, 1.12-1.97) years of intervention. Progression to amputation was found to occur more commonly in the endovascular group at the end of the second (OR, 0.60; 95% CI, 0.42-0.86) and third (OR, 0.55; 95% CI, 0.39-0.77) year of intervention. Higher amputation-free and overall survival rates were found in the bypass group at 4 years (OR, 1.31; 95% CI, 1.07-1.61 and OR, 1.29; 95% CI, 1.04-1.61, respectively).
  
  
  CONCLUSIONS
  High-level evidence demonstrating the superiority of one method over the other is lacking. An endovascular-first approach may be advisable in patients with significant comorbidity, whereas for fit patients with a longer-term perspective a bypass procedure may be offered as a first-line interventional treatment.
authors.affiliation: Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom. antoniou.ga@hotmail.com
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chalmers
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.forename: Miltos K
authors.initials: MK
authors.lastname: Lazarides
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Serracino-Inglott
authors.forename: J Vincent
authors.initials: JV
authors.lastname: Smyth
authors.forename: David
authors.initials: D
authors.lastname: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011150:Popliteal Artery / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality