Abstract：
UNASSIGNED: The purpose of this review and meta-analysis is to determine the clinical outcome differences between patients with chronic limb-threatening ischemia who underwent direct versus indirect angiosome revascularization using either the surgical or endovascular approach.
UNASSIGNED: The data sources used for article selection included PubMed, Embase/Medline, Cochrane reviews, and Web of Science (All studies were in English and included up to September 2023). All articles included were comparative in design, including retrospective, prospective, and randomized controlled trials that compared the clinical outcomes between direct and indirect angiosome-guided revascularization in chronic limb-threatening ischemia. A random-effects model was used to determine the measure of association between direct revascularization and amputation-free survival, wound healing, and overall survival. Publication bias was assessed with both Begg\'s and Egger\'s test, and heterogeneity was calculated using an I2.
UNASSIGNED: Data from 9 articles were analyzed and reported in this review. Direct revascularization was associated with improved amputation-free survival (odds ratio [OR]=2.632, confidence interval [CI]: 1.625, 4.265), binary wound healing (OR=2.262, CI: 1.518, 3.372), and overall survival (OR=1.757, CI: 1.176, 2.625). Time until wound healed was not associated with either direct or indirect revascularization (Standard Mean Difference [SMD]=-2.15, p=0.11). There was a low risk of bias across all studies according to the RoB 2.0 tool.
UNASSIGNED: Direct revascularization is associated with improved amputation-free survival, overall survival, and wound healing in chronic limb-threatening ischemic patients compared to the indirect approach.
CONCLUSIONS: Preservation of the lower extremity is critical for preventing mortality and maintaining independence. The benefit of angiosome-guided revascularization for chronic limb-threatening ischemia remains controversial. The authors of this article aim to review the current literature and compare direct and indirect angiosome-guided intervention for preserving the lower extremity. Current findings suggest direct angiosome-guided intervention reduces amputation rates and improves survival; however, many trials neglect to address the multifactorial approach needed in wound care management.
UNASSIGNED: The data sources used for article selection included PubMed, Embase/Medline, Cochrane reviews, and Web of Science (All studies were in English and included up to September 2023). All articles included were comparative in design, including retrospective, prospective, and randomized controlled trials that compared the clinical outcomes between direct and indirect angiosome-guided revascularization in chronic limb-threatening ischemia. A random-effects model was used to determine the measure of association between direct revascularization and amputation-free survival, wound healing, and overall survival. Publication bias was assessed with both Begg\'s and Egger\'s test, and heterogeneity was calculated using an I2.
UNASSIGNED: Data from 9 articles were analyzed and reported in this review. Direct revascularization was associated with improved amputation-free survival (odds ratio [OR]=2.632, confidence interval [CI]: 1.625, 4.265), binary wound healing (OR=2.262, CI: 1.518, 3.372), and overall survival (OR=1.757, CI: 1.176, 2.625). Time until wound healed was not associated with either direct or indirect revascularization (Standard Mean Difference [SMD]=-2.15, p=0.11). There was a low risk of bias across all studies according to the RoB 2.0 tool.
UNASSIGNED: Direct revascularization is associated with improved amputation-free survival, overall survival, and wound healing in chronic limb-threatening ischemic patients compared to the indirect approach.
CONCLUSIONS: Preservation of the lower extremity is critical for preventing mortality and maintaining independence. The benefit of angiosome-guided revascularization for chronic limb-threatening ischemia remains controversial. The authors of this article aim to review the current literature and compare direct and indirect angiosome-guided intervention for preserving the lower extremity. Current findings suggest direct angiosome-guided intervention reduces amputation rates and improves survival; however, many trials neglect to address the multifactorial approach needed in wound care management.
摘要：
■本综述和荟萃分析的目的是确定使用手术或血管内方法进行直接与间接血管体血运重建的慢性威胁肢体缺血患者之间的临床结果差异。
■用于文章选择的数据源包括PubMed，Embase/Medline,Cochrane评论，和WebofScience（所有研究均为英语，包括到2023年9月）。所有包含的文章都是比较设计的，包括回顾性，prospective,和随机对照试验，比较直接和间接血管体引导的慢性威胁肢体缺血血运重建的临床结果。使用随机效应模型来确定直接血运重建与无截肢生存率之间的相关性。伤口愈合，和总体生存率。发表偏倚用Begg和Egger测试进行评估，异质性是使用I2计算的。
■本综述对9篇文章的数据进行了分析和报道。直接血运重建与改善无截肢生存率相关(比值比[OR]=2.632,置信区间[CI]:1.625,4.265),二元伤口愈合（OR=2.262，CI：1.518，3.372），总生存率(OR=1.757,CI:1.176,2.625)。伤口愈合的时间与直接或间接血运重建无关（标准平均差[SMD]=-2.15，p=0.11）。根据RoB2.0工具，所有研究的偏倚风险都很低。
■直接血运重建与改善无截肢生存率相关，总生存率,与间接方法相比，慢性威胁肢体缺血患者的伤口愈合。
结论：保留下肢对于预防死亡率和维持独立性至关重要。血管体引导的血运重建治疗慢性威胁肢体缺血的益处仍存在争议。本文的作者旨在回顾当前的文献，并比较直接和间接的血管体引导干预保留下肢。目前的研究结果表明，直接血管体引导的干预可降低截肢率并提高生存率；然而，许多试验忽视了伤口护理管理中所需的多因素方法.
■用于文章选择的数据源包括PubMed，Embase/Medline,Cochrane评论，和WebofScience（所有研究均为英语，包括到2023年9月）。所有包含的文章都是比较设计的，包括回顾性，prospective,和随机对照试验，比较直接和间接血管体引导的慢性威胁肢体缺血血运重建的临床结果。使用随机效应模型来确定直接血运重建与无截肢生存率之间的相关性。伤口愈合，和总体生存率。发表偏倚用Begg和Egger测试进行评估，异质性是使用I2计算的。
■本综述对9篇文章的数据进行了分析和报道。直接血运重建与改善无截肢生存率相关(比值比[OR]=2.632,置信区间[CI]:1.625,4.265),二元伤口愈合（OR=2.262，CI：1.518，3.372），总生存率(OR=1.757,CI:1.176,2.625)。伤口愈合的时间与直接或间接血运重建无关（标准平均差[SMD]=-2.15，p=0.11）。根据RoB2.0工具，所有研究的偏倚风险都很低。
■直接血运重建与改善无截肢生存率相关，总生存率,与间接方法相比，慢性威胁肢体缺血患者的伤口愈合。
结论：保留下肢对于预防死亡率和维持独立性至关重要。血管体引导的血运重建治疗慢性威胁肢体缺血的益处仍存在争议。本文的作者旨在回顾当前的文献，并比较直接和间接的血管体引导干预保留下肢。目前的研究结果表明，直接血管体引导的干预可降低截肢率并提高生存率；然而，许多试验忽视了伤口护理管理中所需的多因素方法.
