Navigating treatment choices in acute limb ischemia case: a systematic review
Main Article Content
Keywords
Acute Limb Ischemia, Amputation-Free Survival, Endovascular Treatment, Open Surgery
Abstract
Background: Acute limb ischemia (ALI) is a critical vascular emergency characterized by the sudden reduction of blood flow to a limb, posing a significant risk of tissue loss or death. The primary etiologies are embolism and thrombosis, commonly associated with atrial fibrillation or atherosclerosis. Treatment strategies—including open surgery (OS), endovascular treatment (ET), and hybrid treatment (HT)—are designed to prevent limb amputation after initial intervention, as reinterventions can increase the risk of complications and mortality. This study aims to evaluate and compare the efficacy and safety of OS, ET, and HT in the management of ALI, as well as to identify predictors of clinical outcomes.
Methods: A systematic review was conducted in accordance with PRISMA guidelines, searching PubMed, ScienceDirect, Scopus, and Web of Science for studies comparing OS, ET, and HT in ALI management. Outcomes assessed included amputation-free survival (AFS) at 12 months, 30-day reintervention, and 30-day mortality.
Results: Six studies comprising 2,511 patients were included. The ET group demonstrated significantly higher AFS rates at 12 months compared to OS and HT. There were no statistically significant differences in 30-day reintervention rates among the three modalities. However, 30-day postoperative mortality was significantly higher in patients undergoing OS and HT than in those treated with ET. Advanced age and comorbidities were associated with poorer outcomes across all interventions.
Conclusion: This review highlights the importance of individualized treatment selection in ALI management, as each modality offers distinct advantages and limitations. ET appears favorable for high-risk patients due to its minimally invasive nature and lower short-term mortality, while HT may be particularly beneficial in anatomically complex cases. Further research is needed to optimize long-term outcomes and refine patient-specific treatment strategies.
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