title: Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Critical limb ischaemia (CLI) is the end stage of peripheral artery disease (PAD) and is associated with high amputation and mortality rates and poor quality of life. For CLI patients with no revascularisation options, venous arterialisation could be a last resort for limb salvage.
  
  
  OBJECTIVE
  To review the literature on the clinical effectiveness of venous arterialisation for lower limb salvage in CLI patients with no revascularisation options.
  
  
  METHODS
  Different databases were searched for papers published between January 1966 and January 2016. The criteria for eligible articles were studies describing outcomes of venous arterialisation, published in English, human studies, and with the full text available. Additionally, studies were excluded if they did not report limb salvage, wound healing or amputation as outcome measures. The primary outcome measure was post-operative limb salvage at 12 months. Secondary outcome measures were 30 day or in-hospital mortality, survival, patency, technical success, and wound healing.
  
  
  RESULTS
  Fifteen articles met the inclusion criteria. The included studies described 768 patients. According to the MINORS score, methodological quality was moderate to poor. The estimated pooled limb salvage rate at one year was 75% (0.75, 95% CI 0.70-0.81). Thirty day or in-hospital mortality was reported in 12 studies and ranged from 0 to 10%. Overall survival was reported in 10 studies and ranged from 54% to 100% with a mean follow-up ranging from 5 to 60 months. Six studies reported on patency of the venous arterialisations performed, with a range of 59-71% at 12 months.
  
  
  CONCLUSIONS
  In this systematic review on venous arterialisation in patients with non-reconstructable critical limb ischaemia, the pooled proportion of limb salvage at 12 months was 75%. Venous arterialisation could be a valuable treatment option in patients facing amputation of the affected limb; however, the current evidence is of low quality.
authors.affiliation: Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. Electronic address: m.a.schreve@nwz.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Schreve
authors.affiliation: Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: Vos
authors.affiliation: Department of Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: J P P M
authors.initials: JP
authors.lastname: de Vries
authors.affiliation: Department of Surgery, Changi General Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Kum
authors.affiliation: Department of Surgery, UMCU, Utrecht, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
authors.forename: Ç
authors.initials: Ç
authors.lastname: Ünlü
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014945:Wound Healing
keywords: Critical limb ischaemia; Limb salvage; Venous arterialisation