Critical limb ischemia (CLI) is a severe form of peripheral arterial disease (PAD) marked by ischemic rest pain, tissue loss, or gangrene. CLI is associated with significant morbidity, mortality, and resource utilization. Patients can be treated with revascularization, either surgical or endovascular. To help clinicians, patients, and policymakers decide between surgery-first and endovascular-first approaches in patients with CLI, we were asked to conduct a systematic review of the literature.

Contents

• Preface
• Acknowledgments
• Abstract
  • Introduction
  • Methods
  • Results
  • Discussion
  • Abbreviations Table
• Introduction
• Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Data Synthesis and Analysis
  • Rating the Body of Evidence
  • Peer Review
• Results
  • Literature Flow
  • Description of the Evidence
• Summary and Discussion
  • Summary of Evidence by Key Question
  • Limitations
  • Research Gaps/Future Research
  • Conclusions
• References
• APPENDIX A. Search Strategy
• APPENDIX B. Peer Reviewer Comments and Responses
• APPENDIX C. Cochrane Risk of Bias Tool
• APPENDIX D. Risk of Bias in Non-Randomised Studies – of Interventions (ROBINS-I)
• APPENDIX E. Quality Assessment for Included RCT Study
• APPENDIX F. Quality Assessment for Included Observational Studies
• APPENDIX G. Evidence Table
• APPENDIX H. Citations for Excluded Publications

Suggested citation:

Childers C, Lamaina M, Liu C, Mak S, Booth M, Gibbons M, Shekelle PG. Cost-effectiveness of Leg Bypass versus Endovascular Therapy for Critical Limb Ischemia. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs.VA ESP Project#05-226; 2019. Available at: https://www.hsrd.research.va.gov/publications/esp/reports.cfm.

This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.