title: Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
abstract: BACKGROUND
  For patients with critical limb ischemia (CLI), the optimal treatment to enhance limb preservation, prevent death, and improve functional status is unknown. We performed a systematic review and meta-analysis to assess the comparative effectiveness of endovascular revascularization and surgical revascularization in patients with CLI.
  
  
  METHODS
  We systematically searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1995 to August 2012. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects, with endovascular treatment as the control group.
  
  
  RESULTS
  We identified a total of 23 studies, including 1 randomized controlled trial, which reported no difference in amputation-free survival at 3 years (odds ratio [OR] 1.22, 95% CI 0.84-1.77) and all-cause mortality (OR 1.07, 0.73-1.56) between the 2 treatments. Meta-analysis of the observational studies showed a statistically nonsignificant reduction in all-cause mortality at 6 months (11 studies, OR 0.85, 0.57-1.27) and amputation-free survival at 1 year (2 studies, OR 0.76, 0.48-1.21) in patients treated with endovascular revascularization. There was no difference in overall death, amputation, or amputation-free survival at ≥2 years.
  
  
  CONCLUSIONS
  The currently available literature suggests that there is no difference in clinical outcomes for patients with CLI treated with endovascular or surgical revascularization. There is a paucity of high-quality data available to guide clinical decision making, especially as it pertains to patient subgroups or anatomical considerations.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC. Electronic address: schuyler.jones@dm.duke.edu.
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Vemulapalli
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Kristine
authors.initials: K
authors.lastname: Schmit
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Brooke
authors.initials: B
authors.lastname: Heidenfelder
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
mesh_terms: D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures / Q000379:methods*