For traumatic lower extremity artery injury, it is unclear whether it is better to perform endovascular therapy (ET) or open surgical repair (OSR). This study aimed to compare the clinical outcomes of ET versus OSR for traumatic lower extremity artery injury. The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates. A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21–0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20–0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75–1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%–27%). Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay.

中文翻译：

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血管内治疗与开放手术修复创伤性下肢动脉损伤的系统评价和荟萃分析


对于外伤性下肢动脉损伤，目前尚不清楚是进行血管内治疗（ET）还是开放手术修复（OSR）更好。本研究旨在比较 ET 与 OSR 治疗创伤性下肢动脉损伤的临床结果。在 Medline、Embase 和 Cochrane 数据库中检索研究。报告 ET 或 OSR 结果的队列研究和病例系列符合纳入条件。 Robins-I 工具和 18 项工具用于评估偏倚风险。主要结局是截肢。次要结局包括筋膜切开术或筋膜室综合征、死亡率、住院时间和下肢神经损伤。我们使用随机效应模型来计算汇总估计值。荟萃分析中总共纳入了 32 项具有低或中等偏倚风险的研究。结果显示，接受 ET 的患者发生大截肢（OR = 0.42，95% CI 0.21–0.85；I2=34%）和筋膜切开术或筋膜室综合征（OR = 0.31，95% CI 0.20–0.50， I2 = 14%）高于接受 OSR 的患者。两组之间的全因死亡率没有显着差异（OR = 1.11，95% CI 0.75–1.64，I2 = 31%）。 ET 修复患者的住院时间比 OSR 修复患者的住院时间短（MD=-5.06，95% CI -6.76 至 -3.36，I2 = 65%）。刚刚报道 OSR 患者术中神经损伤，合并发生率为 15%（95% CI 6%–27%）。血管内治疗可能是外伤性下肢动脉损伤患者的更好选择，因为它可以降低截肢、筋膜切开术或筋膜室综合征以及神经损伤的风险，并缩短住院时间。