A Systematic Review of Modern Endovascular Techniques Compared to Surgery for Acute Limb Ischaemia

Abstract

Background: Acute limb ischaemia (ALI) represents a critical vascular emergency, conventionally managed with surgical intervention in cases of threatened limbs. However, the increasing application of modern endovascular techniques, such as percutaneous thrombectomy, has emerged as an alternative treatment approach for ALI. This systematic review evaluates the contemporary management of ALI.

Methods: A comprehensive search strategy using search engines (Cochrane, Medline, PubMed, and Embase) was carried out to identify eligible studies reporting on short and mid-term survival and limb salvage outcomes following percutaneous thrombectomy in the ALI management. This review was registered within the Prospective Register of Systematic Reviews (PROSPERO) database and developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: A total of 1,383 studies were screened, and 25 full-text articles were assessed for eligibility. Sixteen studies met the inclusion criteria and were incorporated into the review, all of which were observational in nature. The included studies reported on the safety and efficacy of mechanical thrombectomy but did not provide comparisons with conventional open surgical interventions. The 30-day and 1-year survival rates following mechanical thrombectomy were 94.7% and 86.6%, respectively. The 30-day and 1-year limb salvage rates were 95.2% and 90.1%, respectively.

Conclusion: Mechanical thrombectomy demonstrates promising short and mid-term outcomes in the management of ALI. However, the lack of direct comparisons with conventional open surgery limits the ability to definitively assess its relative efficacy. Further comparative studies are necessary to establish its role as a primary treatment modality for ALI.