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Systematic Review and Proportional Meta-Analysis of Endarterectomy and Endovascular Therapy with Routine or Selective

Khalid Hamid Changal1, Mubbasher Ameer Syed2, Tawseef Dar3

  • 1Internal Medicine, Mercy Health St. Vincent Medical Center, Toledo, OH, USA.

Journal of Interventional Cardiology
|November 28, 2019
PubMed

Insights

Endovascular treatment with routine stenting (EVT-RS) offers comparable outcomes to common femoral endarterectomy (CFE) for common femoral artery atherosclerotic disease (CFA-ASD). EVT-RS demonstrates lower complication rates and similar long-term patency, supporting its use as an alternative therapy.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Atherosclerosis Research

Background:

  • Common femoral endarterectomy (CFE) has been the standard treatment for common femoral artery atherosclerotic disease (CFA-ASD).
  • Historically, endovascular treatments for CFA-ASD were approached with caution due to concerns about stent durability and future vascular access.
  • Recent advancements suggest CFA may be suitable for endovascular interventions, prompting re-evaluation of treatment strategies.

Purpose of the Study:

  • To conduct a meta-analysis comparing endovascular treatment (EVT) with CFE for CFA-ASD.
  • To evaluate the efficacy and safety of EVT with selective stenting (EVT-SS) and routine stenting (EVT-RS) against CFE.

Main Methods:

  • A systematic search of multiple databases identified 28 studies (7 EVT-RS, 8 EVT-SS, 13 CFE) over the past two decades.
  • Studies were analyzed based on treatment strategy: EVT-RS, EVT-SS, or CFE.
  • Primary outcomes included primary patency (PP), target lesion revascularization (TLR), and complication rates, analyzed using a random-effect model.

Main Results:

  • One-year primary patency was 84% for EVT-RS, 78% for EVT-SS, and 93% for CFE.
  • One-year target lesion revascularization rates were 8% for EVT-RS, 19% for EVT-SS, and 4.5% for CFE.
  • Local complication rates were lower for EVT-RS (5%) and EVT-SS (7%) compared to CFE (22%). Mortality was higher in the CFE group (23.1%) versus EVT-RS (5.3%) at maximum follow-up.

Conclusions:

  • Endovascular treatment with routine stenting (EVT-RS) shows comparable one-year primary patency and target lesion revascularization rates to common femoral endarterectomy (CFE).
  • CFE demonstrated superior one-year primary patency compared to endovascular treatment with selective stenting (EVT-SS).
  • EVT-RS and EVT-SS have significantly lower complication rates than CFE, and EVT-RS presents a viable alternative management strategy for CFA-ASD with comparable long-term patency and lower mortality.
Abstract

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