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CardioVascular and Interventional Radiology

, Volume 43, Issue 2, pp 204–214 | Cite as

Comparative Efficacy and Safety of Endovascular Treatment Modalities for Femoropopliteal Artery Lesions: A Network Meta-analysis of Randomized Controlled Trials

  • Yang Zhou
  • Zhihui ZhangEmail author
  • Shaomang LinEmail author
  • Jianbin Xiao
  • Wenjia Ai
  • Junwei Wang
  • Yangyong Li
  • Qiang Li
Review Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

We conducted a network meta-analysis of randomized controlled trials comparing the efficacy and safety of multiple endovascular treatments for femoropopliteal lesions.

Methods

Nine treatments for femoropopliteal lesions were identified. We compared major amputation and all-cause mortality at 12-month follow-ups and primary patency at 6-, 12- and 24-month follow-ups of the treatments.

Results

Altogether, 26 studies (52 study arms; 4102 patients) were considered eligible. In terms of primary patency, drug-eluting stent (DES) placement was the most effective treatment at 6- and 12-month follow-ups and covered stent (CS) placement at 24-month follow-ups, whereas directional atherectomy (DA) was the least effective treatment during all follow-up periods; both DES and CS placements were better than the majority of other single treatments, including balloon angioplasty, DA, nitinol stent (NS) placement and drug-coated balloon use, during all follow-up periods. In terms of 12-month major amputation and all-cause mortality, DA was the most safe treatment, whereas NS placement was the least safe single treatment.

Conclusions

DES and CS placements have shown encouraging results in terms of primary patency for femoropopliteal lesions, DES placement performs better within 12 months after operation and CS placement at approximately 24 months, while DA seems to be less effective. DA may be better than other treatments in terms of major amputation and all-cause mortality, while NS seems to be less safe.

Keywords

Atherectomy Balloon angioplasty Drug-eluting stents Self-expandable metallic stents Peripheral arterial disease Endovascular procedures Network meta-analysis 

Notes

Funding

This study was funded by Medical Research Project of Guangdong Province, China (Grant Numbers A2012254), providing funding that was used to pay for the editing and publication fees. The funding sources were not involved in the study design; collection, analysis or interpretation of the data; writing of the report; or decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Supplementary material

270_2019_2332_MOESM1_ESM.tif (6.9 mb)
Supplementary Fig. 1Plots of the surface under the cumulative ranking curves (SUCRAs) for primary patency. BA, balloon angioplasty; CS, covered stent; DA, directional atherectomy; DA-DCB, directional atherectomy with drug-coated balloon; DCB, drug-coated balloon; DES, drug-eluting stent; NS, nitinol stent (TIFF 7055 kb)
270_2019_2332_MOESM2_ESM.tif (5.9 mb)
Supplementary Fig. 2Comparison-adjusted funnel plot for all outcome measures. The red line represents the null hypothesis that the study-specific effect sizes do not differ from the respective comparison-specific pooled effect estimates. Different colors correspond to different comparisons. BA, balloon angioplasty; CB, cutting balloon; CS, covered stent; DA, directional atherectomy; DA-DCB, directional atherectomy with drug-coated balloon; DCB, drug-coated balloon; DES, drug-eluting stent; NS, nitinol stent; NS-DCB, nitinol stent with drug-coated balloon (TIFF 6027 kb)
270_2019_2332_MOESM3_ESM.tif (2 mb)
Supplementary Fig. 3Plots of the surface under the cumulative ranking curves (SUCRAs) for major amputation. BA, balloon angioplasty; CB, cutting balloon; CS, covered stent; DA, directional atherectomy; DA-DCB, directional atherectomy with drug-coated balloon; DCB, drug-coated balloon; DES, drug-eluting stent; NS, nitinol stent; NS-DCB, nitinol stent with drug-coated balloon (TIFF 2076 kb)
270_2019_2332_MOESM4_ESM.tif (2 mb)
Supplementary Fig. 4Plots of the surface under the cumulative ranking curves (SUCRAs) for all-cause mortality. BA, balloon angioplasty; CB, cutting balloon; CS, covered stent; DA, directional atherectomy; DA-DCB, directional atherectomy with drug-coated balloon; DCB, drug-coated balloon; DES, drug-eluting stent; NS, nitinol stent; NS-DCB, nitinol stent with drug-coated balloon (TIFF 2076 kb)
270_2019_2332_MOESM5_ESM.docx (24 kb)
Supplementary material 5 (DOCX 23 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Yang Zhou
    • 1
  • Zhihui Zhang
    • 1
    Email author
  • Shaomang Lin
    • 1
    Email author
  • Jianbin Xiao
    • 1
  • Wenjia Ai
    • 1
  • Junwei Wang
    • 1
  • Yangyong Li
    • 1
  • Qiang Li
    • 1
  1. 1.Department of Vascular SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina

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