Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis
David Koeckerling1, Peter Francis Raguindin2,3,4, Lum Kastrati2,5,6
1Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
European Heart Journal
|February 1, 2023
Summary
Drug-coated balloons (DCB) improve outcomes for femoropopliteal disease intermittent claudication (IC) compared to balloon angioplasty (BA). More research is needed for aortoiliac arteries and quality-of-life endpoints.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Intermittent claudication (IC) management via endovascular methods is debated.
- Systematic review and meta-analysis to compare efficacy and safety of various endovascular devices for IC.
Approach:
- Searched randomized controlled trials (RCTs) up to November 2021.
- Evaluated primary patency, target-lesion revascularization (TLR), quality-of-life (QoL), all-cause mortality, and major amputation.
- Analyzed outcomes at short-term, mid-term, and long-term follow-up.
Key Points:
- Drug-coated balloons (DCB) showed higher primary patency and lower TLR in femoropopliteal disease compared to balloon angioplasty (BA).
- Bare-metal stents (BMS) improved short-to-mid-term patency and TLR versus provisional stenting, with similar long-term efficacy.
- Drug-eluting stents (DES) and BMS demonstrated comparable mid-term patency and TLR. Atherectomy offered no significant efficacy benefits.
Conclusions:
- DCBs may offer benefits for femoropopliteal disease, but data for aortoiliac arteries and QoL are limited.
- Evidence gaps hinder determining the optimal endovascular strategy for IC.
- Further high-quality research is necessary to address existing evidence limitations.
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