Open Surgical Versus Endovascular Revascularization in Thromboangitis Obliterans Patients with Chronic Limb Threatening Ischemia - A Systematic Review and Metanalysis.

Abstract

<h4>Background</h4>More than 100 years have passed since Leo Buerger first described thromboangiitis obliterans (TAO). The incidence and prevalence of the disease have since declined, yet TAO remains a challenging condition to treat. Historically, surgical bypass has been the primary revascularization method, while in the past decade, endovascular techniques have increasingly been applied for chronic limb-threatening ischemia (CLTI) in TAO patients. However, comparative outcome data for these 2 strategies remain limited.<h4>Methods</h4>PubMed, Google Scholar, and Scopus were searched on February 15, 2024, for studies comparing surgical and endovascular revascularization in TAO. A systematic review was conducted following PRISMA guidelines using predefined MeSH terms. Studies with full text available that reported limb salvage, patency, technical failure, clinical improvement, or reintervention outcomes were included. Meta-analysis was performed using a random-effects model.<h4>Results</h4>Four studies involving 150 patients (81 endovascular; 69 surgical bypass) met inclusion criteria. No significant differences were observed between groups in limb salvage, technical failure, clinical improvement, or secondary patency at 1 and 3 years. Early (6-month) primary patency was significantly higher in the surgical bypass group, with a pooled estimate of 0.63 (95% CI 0.48-0.82). Endovascular treatment was associated with a significantly higher 1-year reintervention rate (pooled estimate 2.15; 95% CI 1.34-3.44).<h4>Conclusion</h4>Limb salvage outcomes were comparable between surgical and endovascular approaches. However, endovascular interventions demonstrated lower early primary patency and higher reintervention rates in TAO patients presenting with CLTI. These factors should be carefully considered when selecting a revascularization strategy for this patient population.