Comparison Between Endovascular and Open Surgery for the Treatment of Peripheral Artery Diseases: A Meta-Analysis.

The purpose of the study is to compare the efficacy and safety between endovascular surgery and open surgery for the treatment of peripheral arterial disease (PAD). Studies were recruited from EMBASE, PubMed, Cochrane Library, and reviewing reference lists of related studies between June 2017 and December 31, 2018. Data of functional outcomes were extracted in this meta-analysis. Odds ratio or standardized mean differences with its 95% confidence interval (95% CI) were used. Pooled data proved to be absent of heterogeneity were tested by a fixed-effects model; otherwise, we used a random-effects model. All analyses were managed with RevMan 5.3 software (Cochrane Collaboration, London, UK). Twenty-seven trials (7 randomized controlled trials and 20 retrospective trials) involving a total of 17,536 participants were included in our meta-analysis. Data showed that endovascular surgery was accompanied with lower complication rate (426/4,496 [9.48%] vs. 551/4,051 [13.60%]; 95% CI, 0.53 [0.34, 0.82]; I2 = 83%; P = 0.004) and shorter hospital stay (95% CI, -4.01 [-4.99, -3.02]; I2 = 76%; P < 0.00001) than open surgery. Higher amputation (204/1,633 [12.49%] vs. 228/1,247 [18.28%]; 95% CI, 0.72 [0.59, 0.89]; I2 = 12%; P = 0.002) and mortality during follow-up (490/4,514 [10.86%] vs. 341/4,520 [7.54%]; 95% CI, 0.73 [0.61, 0.86]; I2 = 0%; P < 0.05) were found in open surgery group. No evidence showed the rate of technical success, survival, or limb salvage reduced in endovascular surgery. In conclusion, our results showed that endovascular surgery is a promising technique for the treatment of PAD. Our data showed that endovascular surgery has less complication, shorter hospital stay, lower amputation, and mortality rate when compared with open surgery, although no significant difference was observed in survival rate, surgery success, and limb salvage.

[Experimental study of myocardial protective effect of cardiac arrest versus beating heart during open heart surgery].

OBJECTIVE: To investigate the myocardial protective effects of beating heart versus heart arrest in goats undergoing open heart surgery with cardiopulmonary bypass (CPB). METHODS: Eighteen healthy and homologous goats were randomly divided into three groups: groupI (n=6), with intermittent cold crystalloid cardioplegia; group II (n=6), with continuous warm blood cardioplegia; group III (n=6), with beating heart. Animals in group II and group III were operated with mild hypothermic CPB. The changes in malondialdehyde (MDA) in the myocardium of the right ventricles and atrial natriuretic peptide (ANP) in venous blood were measured respectively. The myocardial tissues were examined for ultrastructural changes. RESULTS: In group I, contents of MDA and ANP rose significantly during CPB, especially when blood was reperfused routinely. While in group II and group III, the levels were lower than those in group I at the same time points. There was no difference in the values between group II and group III. Ultrastructural changes were distinctly seen in group I, while they were mild in group II and group III. CONCLUSION: Continuous warm blood cardioplegia to keep the heart beating during operation can prevent ischemia-reperfusion injury and protect heart better.