TY - JOUR
T1 - Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease
T2 - a meta-analysis
AU - Koeckerling, David
AU - Raguindin, Peter Francis
AU - Kastrati, Lum
AU - Bernhard, Sarah
AU - Barker, Joseph
AU - Quiroga Centeno, Andrea Carolina
AU - Raeisi-Dehkordi, Hamidreza
AU - Khatami, Farnaz
AU - Niehot, Christa
AU - Lejay, Anne
AU - Szeberin, Zoltan
AU - Behrendt, Christian-Alexander
AU - Nordanstig, Joakim
AU - Muka, Taulant
AU - Baumgartner, Iris
N1 - Funding Information:
All authors declare no specific funding for this contribution. P.F.R. has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement [grant number 801076], through the SSPH + Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health. L.K. has received a Swiss Government Excellence Scholarship funded by the Swiss Government. J.B. is supported by a National Institute for Health Research (NIHR) academic clinical fellowship. H.R.D. has received funding for his PhD studies by the Swiss National Science Foundation [grant number SNSF IZSTZ0_190277]. T.M. has founded epistudia.com, an online evidence synthesis platform. T.M. and Epistudia have not received any funding for this project. I.B. has received institutional educational grants from Abbott Vascular, Boston Scientific, and Terumo. J.N. has received honoraria from BD (Becton, Dickinson and Company) and Medtronic for LEAD lectures. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
Publisher Copyright:
© The Author(s) 2023.
PY - 2023/3/14
Y1 - 2023/3/14
N2 - AIMS: Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy.METHODS AND RESULTS: Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints.CONCLUSION: Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
AB - AIMS: Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy.METHODS AND RESULTS: Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints.CONCLUSION: Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
KW - Atherectomy
KW - Drug-coated balloon
KW - Drug-eluting stent
KW - Endovascular revascularization
KW - Intermittent claudication
KW - angioplasty
UR - https://www.scopus.com/pages/publications/85161716699
U2 - 10.1093/eurheartj/ehac722
DO - 10.1093/eurheartj/ehac722
M3 - Article
C2 - 36721954
SN - 0195-668X
VL - 44
SP - 935
EP - 950
JO - European heart journal
JF - European heart journal
IS - 11
ER -