Meta-Analysis Comparing Endovascular Treatment Modalities for Femoropopliteal Peripheral Artery Disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Biomaterials Science

Background:

• Femoropopliteal peripheral artery disease (PAD) is a common condition requiring endovascular intervention.
• The comparative effectiveness of various endovascular treatment modalities for PAD is not well-established.
• Standard treatments include balloon angioplasty (BA), bare metal stents (BMS), covered stents (CS), drug-coated balloons (DCB), and drug-eluting stents (DES).

Purpose of the Study:

• To compare the relative efficacy of five endovascular treatment modalities for femoropopliteal peripheral artery disease.
• To evaluate outcomes based on freedom from target lesion revascularization (TLR) and primary patency at 12 months.

Main Methods:

• A Bayesian network meta-analysis was conducted.
• Included 22 trials with 4,381 participants for TLR data and 16 trials with 3,691 participants for primary patency data.
• Balloon angioplasty (BA) served as the reference treatment.

Main Results:

• Drug-coated balloons (DCB) demonstrated the highest efficacy for freedom from target lesion revascularization (TLR) (OR 4.23).
• Drug-eluting stents (DES) showed the highest primary patency rates (OR 8.93).
• DCB, CS, and BMS significantly reduced TLR compared to BA; DCB, DES, CS, and BMS significantly improved primary patency compared to BA.

Conclusions:

• Drug-coated balloons (DCB) are associated with the lowest need for target lesion revascularization (TLR).
• Drug-eluting stents (DES) exhibit the highest primary patency rates.
• DCB, CS, and BMS offer significant TLR reduction, while DCB, DES, CS, and BMS provide significant primary patency improvement over BA.