Singh, Aminder A., Ashcroft, James and Stather, Philip W. ORCID: https://orcid.org/0000-0002-3585-6728
(2021)
Ligation alone versus immediate revascularization for femoral artery pseudoaneurysms secondary to intravascular drug use: A systematic review and meta-analysis.
Annals of Vascular Surgery, 73.
pp. 473-481.
ISSN 0890-5096
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Abstract
Background: Femoral artery pseudoaneurysms (FA-PSAs) remain a common vascular aneurysmal pathology associated with intravascular drug use (IVDU). To date no internationally agreed consensus regarding optimal surgical management of FA-PSAs exists. The aim of this systematic review and meta-analysis was to determine the optimal surgical treatment of FA-PSAs associated with IVDU. Methods: A systematic search was undertaken following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines identifying original studies reporting outcomes of ligation-debridement and/or excision-revascularization of FA-PSAs secondary to IVDU. Outcomes of interest were 30-day mortality, incidence of amputation at 12 months, chronic limb threatening ischemia (CLTI) at any follow-up appointment, reintervention, and bleeding. Results: A total of 39 cohort studies describing 1,217 FA-PSA operative outcomes met inclusion criteria, 993 (81.6%) treated by ligation-debridement and 224 (18.4%) by excision-revascularization. The incidence of 30-day mortality was 0.8% (n = 8) and 1.3% (n = 3) in the ligation-debridement and excision-revascularization groups, respectively, with only one study reporting mortality in both groups. This meta-analysis found no difference in amputation (8.89% vs. 8.03%, odds ratio (OR) 0.74 95% confidence interval (CI) 0.35–1.56, P = 0.42, 11 studies) or CLTI (21.5% vs. 12.4%, OR 1.24 95% CI 0.35–4.38, P = 0.74, 9 studies) after ligation and debridement compared with excision and revascularization. There was a higher incidence of reintervention (24.7% vs. 10.6%, OR 0.31 [95% CI 0.16, 0.62], P = 0.0009, 13 studies) and rebleeding (7.1% vs. 1.6%, OR 0.61 [95% CI 0.16, 2.38], P = 0.48, 5 studies) after excision and revascularization compared with ligation alone. Conclusions: For treatments of IVDU-related FA-PSAs, this study suggests no significant difference in association of mortality, incidence of amputation, or CLTI with ligation-debridement or excision-revascularization, but a significantly higher reintervention rate and greater rebleeding rate for revascularized patients.
Item Type: | Article |
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Additional Information: | Publisher Copyright: © 2020 |
Uncontrolled Keywords: | surgery,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2746 |
Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
Related URLs: | |
Depositing User: | LivePure Connector |
Date Deposited: | 04 Aug 2023 14:31 |
Last Modified: | 07 Aug 2024 01:22 |
URI: | https://ueaeprints.uea.ac.uk/id/eprint/92779 |
DOI: | 10.1016/j.avsg.2020.11.017 |
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