Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review
Abstract Background Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. T...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | Systematic Reviews |
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| Online Access: | http://link.springer.com/article/10.1186/s13643-020-01357-y |
| _version_ | 1811285632024051712 |
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| author | Mark Rockley Prasad Jetty George Wells |
| author_facet | Mark Rockley Prasad Jetty George Wells |
| author_sort | Mark Rockley |
| collection | DOAJ |
| description | Abstract Background Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. This failure rate has prompted investigation into methods of determining physiologic procedural success before and after treatment, before clinically apparent outcomes occur such as gangrene. The aim of this systematic review is to evaluate if in patients undergoing endovascular surgery for lower extremity atherosclerotic peripheral arterial disease, do changes in physiologic measures of perfusion during surgery correlate with clinical outcomes. Methods We registered and designed a study protocol for a systematic review. Literature searches will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977 onwards). Grey literature will be identified through OpenGrey and clinical trial registries, and supplemented by citation searches. We will include randomized controlled trials, quasi-experimental trials, and observational (cohort, case-control) studies conducted in human adults (age 18 or older) who received elective arterial angioplasty for atherosclerotic peripheral vascular disease. The primary outcome of interest will be major adverse limb events. Two investigators will independently screen all citation, full-text articles, and abstract data. The study quality (risk of bias) will be appraised appropriate tools. Data analysis and synthesis will be qualitative; no meta-analysis is planned, as the anticipated homogeneity of measurement and outcome reporting standardization is low. Discussion The treatment of peripheral arterial disease is unique in that the tissue of the ischemic leg is easily accessible for direct monitoring during procedures. This is contrasted with cardiac and neurologic monitoring during cardiac and cerebral procedures, where indirect or invasive measures are required to monitor organ perfusion. Currently synthesized evidence describing limb perfusion focuses on static states of ischemia, and does not evaluate the value of change in perfusion measurement as an indicator of endovascular treatment success. These methods could potentially be applied to optimize procedural outcomes by guiding perfusion-based decision-making during surgery. Systematic review registration PROSPERO CRD42019138192 |
| first_indexed | 2024-04-13T02:47:58Z |
| format | Article |
| id | doaj.art-ad94c95454e84b5395d1798f20ef77be |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-04-13T02:47:58Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-ad94c95454e84b5395d1798f20ef77be2022-12-22T03:05:57ZengBMCSystematic Reviews2046-40532020-05-01911610.1186/s13643-020-01357-yPhysiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic reviewMark Rockley0Prasad Jetty1George Wells2Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic CampusDivision of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital-Civic CampusSchool of Epidemiology and Public Health, Cardiovascular Research Methods Centre, University of Ottawa Heart InstituteAbstract Background Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. This failure rate has prompted investigation into methods of determining physiologic procedural success before and after treatment, before clinically apparent outcomes occur such as gangrene. The aim of this systematic review is to evaluate if in patients undergoing endovascular surgery for lower extremity atherosclerotic peripheral arterial disease, do changes in physiologic measures of perfusion during surgery correlate with clinical outcomes. Methods We registered and designed a study protocol for a systematic review. Literature searches will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977 onwards). Grey literature will be identified through OpenGrey and clinical trial registries, and supplemented by citation searches. We will include randomized controlled trials, quasi-experimental trials, and observational (cohort, case-control) studies conducted in human adults (age 18 or older) who received elective arterial angioplasty for atherosclerotic peripheral vascular disease. The primary outcome of interest will be major adverse limb events. Two investigators will independently screen all citation, full-text articles, and abstract data. The study quality (risk of bias) will be appraised appropriate tools. Data analysis and synthesis will be qualitative; no meta-analysis is planned, as the anticipated homogeneity of measurement and outcome reporting standardization is low. Discussion The treatment of peripheral arterial disease is unique in that the tissue of the ischemic leg is easily accessible for direct monitoring during procedures. This is contrasted with cardiac and neurologic monitoring during cardiac and cerebral procedures, where indirect or invasive measures are required to monitor organ perfusion. Currently synthesized evidence describing limb perfusion focuses on static states of ischemia, and does not evaluate the value of change in perfusion measurement as an indicator of endovascular treatment success. These methods could potentially be applied to optimize procedural outcomes by guiding perfusion-based decision-making during surgery. Systematic review registration PROSPERO CRD42019138192http://link.springer.com/article/10.1186/s13643-020-01357-yAngioplastyPeripheral arterial diseasePerfusionIntraoperative monitoring |
| spellingShingle | Mark Rockley Prasad Jetty George Wells Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review Systematic Reviews Angioplasty Peripheral arterial disease Perfusion Intraoperative monitoring |
| title | Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review |
| title_full | Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review |
| title_fullStr | Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review |
| title_full_unstemmed | Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review |
| title_short | Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review |
| title_sort | physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease protocol for a systematic review |
| topic | Angioplasty Peripheral arterial disease Perfusion Intraoperative monitoring |
| url | http://link.springer.com/article/10.1186/s13643-020-01357-y |
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