Endovascular Therapy Versus Open Surgical Repair for Lower Limb Vascular Trauma

Abstract

Introduction: Lower limb vascular trauma is a time-critical emergency with a high risk of limb loss. Open surgical repair (OSR) has traditionally been the standard treatment, but endovascular therapy (ET) is increasingly utilized. This study aimed to compare the effectiveness and safety of ET versus OSR.
Methods: A systematic review and meta-analysis of comparative observational studies was performed. Adult patients with traumatic lower limb arterial injuries involving the popliteal artery and/or superficial femoral artery were included. A random-effects model was used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I² statistic.
Results: Six retrospective cohort studies involving 9,503 patients were included. Of these, 1,315 patients underwent ET and 8,188 underwent OSR. ET was associated with a reduced risk of amputation compared with OSR (RR 0.67; 95% CI 0.50–0.91). Subgroup analyses demonstrated no significant difference in blunt (RR 0.90; 95% CI 0.59–1.37) or penetrating popliteal artery injuries (RR 0.84; 95% CI 0.21–3.34). ET significantly reduced the risk of compartment syndrome (RR 0.43; 95% CI 0.33–0.56) and the need for fasciotomy (RR 0.43; 95% CI 0.27–0.69).
Conclusions: ET might provide limb salvage outcomes comparable to OSR while significantly reducing ischemia-related morbidity, particularly compartment syndrome and fasciotomy. These findings suggest that ET may be considered in selected patients, although the evidence remains limited.