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. 2021 Mar;55(1):69-76.
doi: 10.4314/gmj.v55i1.10.

Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

Lily P Wu  1 , Nadraj G Naidoo  2 , Olatunji O Adetokunboh  3
Affiliations

Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

Lily P Wu et al. Ghana Med J. 2021 Mar.

Abstract

Background: A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes.

Design: PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as "peripheral arterial disease" AND "critical limb ischemia," "post-operative outcome," AND "predictors of post-operative outcomes". Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score.

Results: The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome.

Conclusion: Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation.

Funding: None declared.

Keywords: Peripheral arterial disease; critical limb ischemia; post-operative outcomes.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
MINORS quality score
Figure 2
Figure 2
Flowchart of literature Search
Figure 3a
Figure 3a
Forest plot of meta-analysis of the proportion estimates for post-operative outcome: limb salvage
Figure 3b
Figure 3b
Forest plot of meta-analysis of the proportion estimates for post-operative outcome: primary graft patency
Figure 3c
Figure 3c
Forest plot of meta-analysis of the proportion estimates for post-operative outcome: ambulatory recovery
Figure 3d
Figure 3d
Forest plot of meta-analysis of the proportion estimates for post-operative outcome: wound healing
See this image and copyright information in PMC

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