Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis.

Koeckerling, David; Raguindin, Peter Francis; Kastrati, Lum; Bernhard, Sarah; Barker, Joseph; Centeno, Andrea Carolina Quiroga; Raeisi-Dehkordi, Hamidreza; Khatami, Farnaz; Niehot, Christa; Lejay, Anne; Szeberin, Zoltan; Behrendt, Christian-Alexander; Nordanstig, Joakim; Muka, Taulant; Baumgartner, Iris (2023). Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. European Heart Journal, 44(11), pp. 935-950. Oxford University Press 10.1093/eurheartj/ehac722

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Köckerling, David, Raguindin, Peter Francis, Kastrati, Lum, Bernhard, Sarah Maike, Raeisidehkordi, Hamidreza, Khatami, Farnaz, Muka, Taulant, Baumgartner, Iris

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Pubmed Import

Date Deposited:

02 Feb 2023 14:09

Last Modified:

14 Mar 2023 19:18

Publisher DOI:

10.1093/eurheartj/ehac722

PubMed ID:

36721954

Uncontrolled Keywords:

Atherectomy Drug-coated balloon Drug-eluting stent Endovascular revascularization Intermittent claudication angioplasty

BORIS DOI:

10.48350/178292

URI:

https://boris.unibe.ch/id/eprint/178292

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