SRS267 - Umbrella review of peri-operative interventions in peripheral arterial disease

Abstract Background Patients with peripheral arterial disease (PAD) are a highly co-morbid cohort with poor revascularisation outcomes. Currently no standardised approach exists for optimising this cohort in the peri-operative period, particularly in Chronic Limb Threatening Ischaemia (CLTI). The aim of this study was to summarise evidence-based peri-operative interventions to improve patient-centred outcomes in PAD patients undergoing revascularisation. Methods The umbrella review included systematic reviews containing evidence for PAD peri-operative interventions, including secondary or community care. Results were reported as per Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist and registered a priori PROSPERO [CRD42024529255]. Searches were carried out in PubMed, Cochrane, PEDro and CINAHL (Inception—May 2024). Primary outcomes included mortality, morbidity and walking measures. Papers were assessed for quality with AMSTAR-2 and GRADE analysis. Interventions were given a red (harm), amber (uncertainty/no effect) or green rating (benefit) based on a P < 0.05 ,95% c.i., number of patients, number of randomised controlled trials (RCTS) and quality assessment. Results Twenty-one systematic reviews were identified, CLTI and amputees were understudied. Intervention themes included: exercise, pharmacological, dressings, ultrasound and other therapies. Eleven studies were rated as ‘green’. Personalised exercise, best medical therapies and negative pressure dressings had high quality evidence for their use. Traditional smoking cessation methods were ineffective. No primary RCTs were conducted in pre-habilitation. Conclusions Multimodal interventions for PAD peri-operatively show promise. Pragmatic trials incorporating these elements and those from other specialty review papers should be conducted. Future high quality RCTs are needed within CLTI and amputees, particularly in pre-habilitation.