Endovascular versus Hybrid revascularization in TASC C/D Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

Objective To compare endovascular (EVT) and hybrid (HB) revascularization results in patients with TASC C/D aortoiliac occlusive disease (AIOD), evaluating differences in primary patency, secondary patency, surgical wound complications, major amputation and mortality. Methods PubMed, Embase and Cochrane were systematically searched for studies that compared EVT versus HB revascularization (common femoral artery endarterectomy plus iliac/aortoiliac stenting) in AIOD. Eligible studies were screened according to predefined inclusion and exclusion criteria. Time-to-event patency outcomes were analyzed through the extraction with WebPlotDigitizer and calculated as hazard ratios (HR). Surgical wound complications, major amputation and mortality were analyzed as event-based outcomes, expressed as risk ratios (RR). Heterogeneity was assessed with Cochran's Q test and Higgins–Thompson I 2 statistics. P values <0.05 were considered statistically significant. Results A total of six studies were included. The HB revascularization demonstrated a higher primary patency [HR 0.48; 95% CI 0.27-0.86, p=0.01, I 2 =0%] and a significantly elevated rate of surgical wound infection [RR 40.93; 95% CI 3.21-521.75, p=0.004, I 2 =38.8%]. In contrast, secondary patency had no statistical significance for the EVT and HB groups [HR 0.72; 95% CI 0.31-1.69, p=0.45, I 2 =0%]. No statistical significance was found in hematoma rate [RR 4.66; 95% CI 0.80-27.01, p=0.08, I 2 =0%], major amputation [RR 0.83; 95% CI 0.15-4.65, p=0.831, I 2 =0%] and mortality [RR 0.61; 95% CI 0.28-1.34, p=0.218, I 2 =0%]. Conclusion In patients with TASC C/D aortoiliac occlusive disease, hybrid revascularization demonstrated higher primary patency and an increased incidence of surgical site infection. Given the limited number of infection events, this specific finding warrants cautious interpretation. Secondary patency, hematoma, major amputation, and mortality were not statistically significant between hybrid and endovascular groups.