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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

A systematic review of endovascular treatment of extensive aortoiliac occlusive disease

V Jongkind, GJ Akkersdijk, KK Yeung, and W Wisselink.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

The authors concluded that endovascular treatment of extensive aortoiliac occlusive disease can be performed successfully by experienced interventionists in selected patients. Although primary patency rates were lower than those reported for surgical revascularisation, reinterventions could often be performed percutaneously, with secondary patency comparable to surgical repair. Small sample sizes and potential for publication bias limit the reliability of the conclusions.

Authors' objectives

To assess contemporary short- and long-term results of endovascular therapy for extensive aortoiliac occlusive disease (AIOD).

Searching

MEDLINE, EMBASE and The Cochrane Library were searched from January 2000 to June 2009. Search terms were reported. Reference lists of included studies were handsearched. Only studies published in English or Dutch were considered. No attempts were made to search for unpublished papers.

Study selection

Studies that reported endovascular treatment of extensive AIOD (TASC type C and D lesions) were eligible for inclusion. Studies had to report the morphology of aortoiliac occlusive lesions. Studies where aortoiliac occlusive lesions were accurately described and where AIOD could be assumed by both reviewers were eligible for inclusion even if they did not use TASC or SCVIR (Society of Cardiovascular and Interventional Radiology) classifications. Further eligibility criteria were reported in the paper. Outcome measures were technical success (defined in most studies as less than 30% residual diameter stenosis and/or residual translesion pressure gradient of less than 5mmHg or 10mmHg), clinical success, mortality, complications and long-term primary and secondary patency rates.

Most studies were conducted in Europe; most used TASC classification to describe aortoiliac lesions. Most patients had extensive AIOD. Mean age ranged from 59 to 67 years. Hybrid techniques (combined surgery and endovascular) were varied. Surgical outflow procedures were varied (endarterectomy of common femoral artery, femoro-femoral bypass, femoro-popliteal bypass). Primary stenting was used in most studies; various bare stents or endografts were used.

Two reviewers independently assessed studies for inclusion; disagreements were resolved by discussion.

Assessment of study quality

Two reviewers independently assessed study quality using a critical review checklist. Key criteria assessed included definition of study population, selection bias, description of method of intervention, description of outcome, data collection (independent or blinded observers), loss of patients to follow-up and description of confounders. Further criteria were reported. Each item was scored on a scale of zero to 2 (maximum score was 12). Disagreements were resolved by discussion.

Data extraction

Two reviewers independently extracted data on outcome measures using a standardised form. Where combined results for limited and extensive AIOD were reported, only data on extensive disease was extracted. Disagreements were resolved by discussion.

Methods of synthesis

Results were summarised in a descriptive synthesis.

Results of the review

Nineteen non-randomised cohort studies were included (n=1,711 participants, range, 19 to 375). Study quality scores varied from 6 to 10.

Technical success rate was achieved in 86% to 100% of patients (19 studies).

Clinical outcomes improved in 83% to 100% of patients (12 studies).

No perioperative or 30-day mortality was reported 12 studies; mortality rate ranged from 1.2% to 6.7% in seven studies.

Morbidity (16 studies): Morbidity rates ranged from 3% to 45% in 15 studies. The most common complications were access site haematomas, distal embolisation, arterial dissections, pseudoaneurysms and iliac artery or aortic ruptures. Major complication was reported in one study.

Patency rates (19 studies): One-year primary patency rates were 70% to 97% and secondary rates were 88% to 100%. Four- or five-year primary patency rates were 60% to 86% and secondary rates were 80% to 98%.

Mean length of stay (seven studies) ranged from one to 4.8 days.

Authors' conclusions

Endovascular treatment of extensive aortoiliac occlusive disease can be performed successfully by experienced interventionists in selected patients. Although primary patency rates are lower than those reported for surgical revascularisation, reinterventions can often be performed percutaneously, with secondary patency comparable to surgical repair.

CRD commentary

The review addressed a clear question with a well-defined inclusion criteria. Three databases were searched for papers written in English or Dutch and time restrictions were applied; therefore, a number of relevant studies may have been missed. There was no search for unpublished data, so publication bias was a risk. Review processes were conducted in duplicate, which minimised risks of error and bias. Study quality was assessed using a checklist (considered inadequate criteria) and an additional appropriate criteria and the results were used to inform synthesis of results. The decision to combine results in a narrative synthesis was appropriate given significant study differences. Sample sizes were small in most studies.

The conclusions reflect the evidence presented, but small sample sizes and potential for language and publication biases limit the reliability of the conclusions.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further large prospective studies were needed to confirm the potential advantages of endovascular treatment over surgery for extensive AIOD.

Funding

None stated.

Bibliographic details

Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. Journal of Vascular Surgery 2010; 52(5): 1376-1383. [PubMed: 20598474]

Indexing Status

Subject indexing assigned by NLM

MeSH

Aged; Angioplasty, Balloon /adverse effects /instrumentation; Aortic Diseases /physiopathology /surgery; Arterial Occlusive Diseases /physiopathology /surgery; Constriction, Pathologic; Endovascular Procedures /adverse effects /instrumentation; Female; Humans; Iliac Artery /physiopathology /surgery; Male; Middle Aged; Risk Assessment; Stents; Time Factors; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures /adverse effects

AccessionNumber

12011000404

Database entry date

27/07/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20598474