Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease

Abstract

Background: There are several additional techniques designed to enhance conventional percutaneous transluminal balloon angioplasty (PTA). This systematic review assessed current evidence on the clinical effectiveness of additional techniques for infrainguinal peripheral arterial occlusive disease (PAD).Methods: Relevant electronic databases, including MEDLINE, were searched in May 2011. The population comprised participants with symptomatic PAD undergoing endovascular treatment for disease distal to the inguinal ligament. Interventions were additional techniques compared with conventional PTA. Main outcome measures were restenosis and need for reintervention. Randomized clinical trials (RCTs) of clinical effectiveness were assessed for quality and data were extracted. Where appropriate, meta-analysis was undertaken to produce risk ratios (RRs).Results: Forty RCTs were selected. Meta-analysis showed a significant benefit in reducing restenosis rates at 6 months for self-expanding stents (RR 0·49) and drug-coated balloons (RR 0·40), and at 12 months for endovascular brachytherapy (RR 0·63). There was also evidence that use of a stent-graft significantly reduced restenosis compared with PTA, as did drug-eluting stents compared with baremetal stents. Meta-analysis showed that use of drug-coated balloons was associated with significantly lower reintervention rates than PTA alone at 6 months (RR 0·24) and 24 months (RR 0·27) of follow-up. There was also evidence of significantly lower reintervention rates for self-expanding stents at 6 months. Other techniques did not show significant treatment effects for restenosis or reintervention. Conclusion:The conclusions of this review should be tempered by small sample sizes, lack of clinical outcome measures and differing outcome definitions, making direct comparison across trials difficult. However, self-expanding stents, drug-eluting stents and drug-coated balloons appeared to be the most promising technologies worthy of future study.

Radiation Dosage for Percutaneous PAD Treatment is Different in Cardiovascular Disciplines: Results From an Eleven Year Population Based Registry in the Metropolitan Area of Hamburg

“…11 While current guidelines and systematic reviews favour stenting and drug-coated devices to treat lesions above the knee, PTA alone remains the gold standard for treatment below the knee. 12 Furthermore, the significantly lower DAP values in surgical units might be explained by non-surgical units being more prone to solve even complex lesions in advanced diseases by endovascular means as their sole option of treatment. The vascular surgeon may be more likely however to outweigh catheter based treatment options for complex lesions with alternatives of open reconstructions.…”

Endovascular treatment of femoro-popliteal artery stenosis/obstruction using a repositionable self-expanding nitinol stent: a preliminary study

“…In a recent meta-analysis including a total 40 randomized trials, Simpson et al [13] sought to determine whether patients undergoing endovascular treatment for femoro-popliteal artery stenosis/occlusion benefited from additional techniques including self-expanding stents, drug-coated balloons, and drug-eluting stents. The authors reported that self-expanding stents were associated with a lower restenosis rate at 6 months and also that stent grafting significantly reduced restenosis compared to percutaneous transluminal angioplasty alone.…”

Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study

“…It was assumed that all re-interventions performed were either bypass surgery (for acute failure; defined as within 30 days) or PTA with bail-out BMS (for failure after 30 days). A systematic review and meta-analysis were carried out to generate data on clinical effectiveness 6. Searches were conducted in May 2011.…”