Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis.

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 91(7):1320-1328, 2018 06.PMID: 29332315Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Endovascular Procedures | *Femoral Artery/su [Surgery] | *Peripheral Arterial Disease/su [Surgery] | *Popliteal Artery/su [Surgery] | *Vascular Grafting | Aged | Aged, 80 and over | Amputation | Bayes Theorem | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/is [Instrumentation] | Endovascular Procedures/mo [Mortality] | Female | Femoral Artery/pp [Physiopathology] | Humans | Limb Salvage | Male | Middle Aged | Peripheral Arterial Disease/di [Diagnosis] | Peripheral Arterial Disease/mo [Mortality] | Peripheral Arterial Disease/pp [Physiopathology] | Popliteal Artery/pp [Physiopathology] | Randomized Controlled Trials as Topic | Risk Factors | Stents | Time Factors | Treatment Outcome | Vascular Grafting/ae [Adverse Effects] | Vascular Grafting/mo [Mortality] | Vascular PatencyYear: 2018Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: Peripheral artery disease (PAD) is a prevalent morbidity that is treated with various strategies.CONCLUSION: Treatment of femoro-popliteal disease has significantly evolved in recent years, with higher rates of patency and freedom from TLR. However, the utility of these treatment strategies in terms of reduction of amputations and overall survival remains in question.Copyright (c) 2018 Wiley Periodicals, Inc.METHODS: We performed a MEDLINE search for randomized studies comparing at least 2 treatment strategies, including bypass surgery, percutaneous transluminal angioplasty (PTA) balloons, stents, covered stents, drug-eluting stents (DES), and drug-coated balloons (DCB), in patients with native femoro-popliteal disease. Mixed treatment comparison model generation was performed to directly and indirectly compare the strategies in terms of restenosis and target lesion revascularization (TLR) presented as odds ratios (OR, [95% credible intervals]).OBJECTIVES: We sought to compare treatment strategies in a Bayesian network meta-analysis of randomized controlled trials.RESULTS: Twenty-nine studies with 4,820 patients were included in the present study. PTA was the largest group with 1,900 patients, followed by DCB (n=1,343), bare metal stents (n=941), covered stents (n=304), DES (n=236), and bypass (n=92). Mean age was 68+/-9 years, 64% were male, 37% diabetic, and 55% smokers. Mean lesion length was 77+/-44 mm, and 39% were total occlusions. Bayesian hierarchical random-effects model demonstrated all treatments were significantly better than, or had a trend toward superiority over, PTA, with DCB ranking well in both restenosis (OR=0.29, [0.17-0.47]) and TLR (OR=0.31, [0.20-0.46]). Nonetheless, none of the therapies showed superiority in terms of survival or amputations.All authors: Bernardo NL, Buchanan K, Escarcega RO, Koifman E, Lipinski MJ, Waksman R, Yu Kang WFiscal year: FY2018Digital Object Identifier: ORCID: Date added to catalog: 2018-01-22
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29332315 Available 29332315

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: Peripheral artery disease (PAD) is a prevalent morbidity that is treated with various strategies.

CONCLUSION: Treatment of femoro-popliteal disease has significantly evolved in recent years, with higher rates of patency and freedom from TLR. However, the utility of these treatment strategies in terms of reduction of amputations and overall survival remains in question.

Copyright (c) 2018 Wiley Periodicals, Inc.

METHODS: We performed a MEDLINE search for randomized studies comparing at least 2 treatment strategies, including bypass surgery, percutaneous transluminal angioplasty (PTA) balloons, stents, covered stents, drug-eluting stents (DES), and drug-coated balloons (DCB), in patients with native femoro-popliteal disease. Mixed treatment comparison model generation was performed to directly and indirectly compare the strategies in terms of restenosis and target lesion revascularization (TLR) presented as odds ratios (OR, [95% credible intervals]).

OBJECTIVES: We sought to compare treatment strategies in a Bayesian network meta-analysis of randomized controlled trials.

RESULTS: Twenty-nine studies with 4,820 patients were included in the present study. PTA was the largest group with 1,900 patients, followed by DCB (n=1,343), bare metal stents (n=941), covered stents (n=304), DES (n=236), and bypass (n=92). Mean age was 68+/-9 years, 64% were male, 37% diabetic, and 55% smokers. Mean lesion length was 77+/-44 mm, and 39% were total occlusions. Bayesian hierarchical random-effects model demonstrated all treatments were significantly better than, or had a trend toward superiority over, PTA, with DCB ranking well in both restenosis (OR=0.29, [0.17-0.47]) and TLR (OR=0.31, [0.20-0.46]). Nonetheless, none of the therapies showed superiority in terms of survival or amputations.

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