A systematic review and meta-analysis of early and long-term outcomes after endovascular interventions in patients with thromboangiitis obliterans and critical limb ischemia with GRADE assessment

Thromboangiitis obliterans (TAO) is a rare inflammatory occlusive vascular disorder that affects small and medium-sized vessels and often progresses to critical limb ischemia (CLI). Although various treatments have been used in advanced stages, endovascular interventions have increasingly gained attention as a limb-saving therapy. Due to limited and varied evidence in published studies, this systematic review and meta-analysis evaluates the early and long-term outcomes of endovascular treatments in patients with TAO-related CLI. This systematic review and meta-analysis was conducted according to PRISMA guidelines and registered on PROSPERO (CRD420251089226). PubMed, Scopus, WOS, Embase, and Google Scholar databases were searched with relevant keywords up to July 2025. A total of 27 studies involving 1,217 patients were included. Pooled outcomes were estimated using a generalized linear mixed model (GLMM). Heterogeneity was assessed using the I² statistic, and potential publication bias was examined via funnel plots and Egger’s test. The pooled technical success rate for endovascular procedures was 89%, with limb salvage rates of 94% at 6 months and 97% at 12 months. Primary patency was 56% at 6 months, 73% at 12 months, and 61% at 36 months; these findings highlight temporal variability, and cross-time comparisons should be interpreted with caution. Secondary patency was initially higher but also decreased over long-term follow-up. Restenosis rates were 15% early and 34% late. Major and minor amputation rates were 10% and 13%, respectively. No in-hospital mortality was reported. Endovascular therapy represents a safe and effective option for treating TAO-related CLI, especially in patients who are not candidates for surgery. While early results are promising, the loss of patency and rising restenosis over time highlight the importance of careful follow-up and proper patient selection. Our findings support a personalized, multidisciplinary approach to managing TAO and emphasize the vital role of smoking cessation in improving clinical outcomes.