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

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  • Arterial Interventions
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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.

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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.

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Authors and Affiliations

  1. Department of Vascular Surgery, The Second Affiliated Hospital of Guangzhou Medical University, No. 250 Changgang East Road, Haizhu District, Guangzhou, 510260, Guangdong, China

    Yang Zhou, Zhihui Zhang, Shaomang Lin, Jianbin Xiao, Wenjia Ai, Junwei Wang, Yangyong Li & Qiang Li

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  1. Yang Zhou
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Correspondence to Zhihui Zhang or Shaomang Lin.

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Supplementary Fig. 1

Plots 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)

Supplementary Fig. 2

Comparison-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)

Supplementary Fig. 3

Plots 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)

Supplementary Fig. 4

Plots 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)

Supplementary material 5 (DOCX 23 kb)

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Zhou, Y., Zhang, Z., Lin, S. et al. Comparative Efficacy and Safety of Endovascular Treatment Modalities for Femoropopliteal Artery Lesions: A Network Meta-analysis of Randomized Controlled Trials. Cardiovasc Intervent Radiol 43, 204–214 (2020). https://doi.org/10.1007/s00270-019-02332-4

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