Author + information
- Edward Koifman,
- Michael Lipinski,
- Won Yu Kang,
- Ricardo Escarcega,
- Ron Waksman and
- Nelson Bernardo
Peripheral arterial disease (PAD) is a prevalent morbidity, which is treated with various strategies including bypass surgery, percutaneous transluminal angioplasty (PTA), bare-metal stents (BMS), covered stents, drug-eluting stents (DES) and drug-coated balloons (DCB). Our goal was to compare the different treatment strategies in a Bayesian network meta-analysis of randomized controlled trials.
We performed a MEDLINE search for randomized studies comparing at least 2 treatment strategies including bypass surgery, PTA, stents, covered stents, DES and DCB in patients with native femoro-popliteal disease. Mixed treatment comparison model generation was performed to directly and indirectly compare the different strategies in terms of restenosis and target lesion revascularization (TLR) presented as odds ratios (OR, [95% credible intervals]).
Twenty-seven studies were identified including 98 bypass patients, 304 covered stent patients, and included 4,415 patients with 4,434 lesions. PTA was the largest group with 1,793 patients, followed by DCB (n=1055), stent (n=946), covered stent (n=304), DES (n=238) and bypass (n=98). Mean age was 68 years, 62% were male, 36% diabetic and 55% were smokers. Mean lesion length was 7.8cm and 41% were total occlusions, 49% of the lesions had moderate to severe calcification. Bayesian hierarchical random-effects model demonstrated all treatments were either significantly better or had a trend toward superiority over PTA, with DCB ranking well in both restenosis (OR=0.40, [0.22-0.73]) and TLR (OR=0.30, [0.19-0.46]).
Treatment of femoro-popliteal disease has significantly evolved in recent years with higher rates of patency and freedom from TLR, especially with DCB.