Nonrevascularization-based treatments in patients with severe or critical limb ischemia

Abd Moain Abu Dabrh, Mark W. Steffen, Noor Asi, Chaitanya Undavalli, Zhen Wang, Mohamed B. Elamin, Michael S. Conte, Mohammad H Murad

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective The aim of this systematic review was to synthesize the existing evidence about various nonrevascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization. Methods We systematically searched multiple databases through November 2014 for controlled randomized and nonrandomized studies comparing the effect of medical therapies (prostaglandin E1 and angiogenic growth factors) and devices (pumps and spinal cord stimulators). We report odds ratios (ORs) and 95% confidence intervals (CIs) of the outcomes of interest pooling data across studies using the random effects model. Results We included 19 studies that enrolled 2779 patients. None of the nonrevascularization-based treatments were associated with a significant effect on mortality. Intermittent pneumatic compression (OR, 0.14; 95% CI, 0.04-0.55) and spinal cord stimulators (OR, 0.53; 95% CI, 0.36-0.79) were associated with reduced risk of amputation. A priori established subgroup analyses (combined vs single therapy; randomized vs nonrandomized) were not statistically significant. Conclusions Very low-quality evidence, mainly due to imprecision and increased risk of bias, suggests that intermittent pneumatic compression and spinal cord stimulators may reduce the risk of amputations. Evidence supporting other medical therapies is insufficient.

Original languageEnglish (US)
Pages (from-to)1330-1339.e13
JournalJournal of Vascular Surgery
Volume62
Issue number5
DOIs
StatePublished - Nov 1 2015

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Ischemia
Extremities
Odds Ratio
Confidence Intervals
Amputation
Spinal Cord
Therapeutics
Spinal Cord Compression
Alprostadil
Angiogenesis Inducing Agents
Meta-Analysis
Intercellular Signaling Peptides and Proteins
Databases
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Nonrevascularization-based treatments in patients with severe or critical limb ischemia. / Abu Dabrh, Abd Moain; Steffen, Mark W.; Asi, Noor; Undavalli, Chaitanya; Wang, Zhen; Elamin, Mohamed B.; Conte, Michael S.; Murad, Mohammad H.

In: Journal of Vascular Surgery, Vol. 62, No. 5, 01.11.2015, p. 1330-1339.e13.

Research output: Contribution to journalArticle

Abu Dabrh, Abd Moain ; Steffen, Mark W. ; Asi, Noor ; Undavalli, Chaitanya ; Wang, Zhen ; Elamin, Mohamed B. ; Conte, Michael S. ; Murad, Mohammad H. / Nonrevascularization-based treatments in patients with severe or critical limb ischemia. In: Journal of Vascular Surgery. 2015 ; Vol. 62, No. 5. pp. 1330-1339.e13.
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abstract = "Objective The aim of this systematic review was to synthesize the existing evidence about various nonrevascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization. Methods We systematically searched multiple databases through November 2014 for controlled randomized and nonrandomized studies comparing the effect of medical therapies (prostaglandin E1 and angiogenic growth factors) and devices (pumps and spinal cord stimulators). We report odds ratios (ORs) and 95{\%} confidence intervals (CIs) of the outcomes of interest pooling data across studies using the random effects model. Results We included 19 studies that enrolled 2779 patients. None of the nonrevascularization-based treatments were associated with a significant effect on mortality. Intermittent pneumatic compression (OR, 0.14; 95{\%} CI, 0.04-0.55) and spinal cord stimulators (OR, 0.53; 95{\%} CI, 0.36-0.79) were associated with reduced risk of amputation. A priori established subgroup analyses (combined vs single therapy; randomized vs nonrandomized) were not statistically significant. Conclusions Very low-quality evidence, mainly due to imprecision and increased risk of bias, suggests that intermittent pneumatic compression and spinal cord stimulators may reduce the risk of amputations. Evidence supporting other medical therapies is insufficient.",
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N2 - Objective The aim of this systematic review was to synthesize the existing evidence about various nonrevascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization. Methods We systematically searched multiple databases through November 2014 for controlled randomized and nonrandomized studies comparing the effect of medical therapies (prostaglandin E1 and angiogenic growth factors) and devices (pumps and spinal cord stimulators). We report odds ratios (ORs) and 95% confidence intervals (CIs) of the outcomes of interest pooling data across studies using the random effects model. Results We included 19 studies that enrolled 2779 patients. None of the nonrevascularization-based treatments were associated with a significant effect on mortality. Intermittent pneumatic compression (OR, 0.14; 95% CI, 0.04-0.55) and spinal cord stimulators (OR, 0.53; 95% CI, 0.36-0.79) were associated with reduced risk of amputation. A priori established subgroup analyses (combined vs single therapy; randomized vs nonrandomized) were not statistically significant. Conclusions Very low-quality evidence, mainly due to imprecision and increased risk of bias, suggests that intermittent pneumatic compression and spinal cord stimulators may reduce the risk of amputations. Evidence supporting other medical therapies is insufficient.

AB - Objective The aim of this systematic review was to synthesize the existing evidence about various nonrevascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization. Methods We systematically searched multiple databases through November 2014 for controlled randomized and nonrandomized studies comparing the effect of medical therapies (prostaglandin E1 and angiogenic growth factors) and devices (pumps and spinal cord stimulators). We report odds ratios (ORs) and 95% confidence intervals (CIs) of the outcomes of interest pooling data across studies using the random effects model. Results We included 19 studies that enrolled 2779 patients. None of the nonrevascularization-based treatments were associated with a significant effect on mortality. Intermittent pneumatic compression (OR, 0.14; 95% CI, 0.04-0.55) and spinal cord stimulators (OR, 0.53; 95% CI, 0.36-0.79) were associated with reduced risk of amputation. A priori established subgroup analyses (combined vs single therapy; randomized vs nonrandomized) were not statistically significant. Conclusions Very low-quality evidence, mainly due to imprecision and increased risk of bias, suggests that intermittent pneumatic compression and spinal cord stimulators may reduce the risk of amputations. Evidence supporting other medical therapies is insufficient.

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