Changal Khalid, Patel Mitra, Devarasetty Pratyush Pavan, Royfman Rachel, Veria Spiro, Vyas Rohit, Mhanna Mohammed, Patel Neha, Beran Azizullah, Burket Mark, Gupta Rajesh
Cardiovascular Medicine, University of Toledo College of Medicine and Health Sciences, Toledo, Ohio.
Department of Medicine, University of Toledo College of Medicine and Health Sciences, Toledo, Ohio.
J Soc Cardiovasc Angiogr Interv. 2022 Apr 11;1(2):100024. doi: 10.1016/j.jscai.2022.100024. eCollection 2022 Mar-Apr.
Balloon angioplasty is the standard endovascular treatment for symptomatic infrapopliteal peripheral artery disease (PAD). However, recent trials have studied the effectiveness of drug-eluting stents (DES) for infrapopliteal PAD.
This study investigated the use of DES compared with standard endovascular techniques for treatment of infrapopliteal artery disease.
This is a comprehensive systematic review and meta-analysis of 9 recent randomized controlled trials. The primary clinical outcome assessed was primary patency. The secondary outcomes were target lesion revascularization (TLR), major limb amputation, and all-cause mortality.
A total of 945 patients met the inclusion criteria. Patients treated with DES were found to have increased primary patency than control at maximum follow-up (hazard ratio [HR] 2.17, 95% confidence interval [CI] 1.58-2.97, < .0001, I = 62%). A similar result was seen in the subgroup of patients with critical limb ischemia (HR 2.58, 95% CI 1.49-4.49, = .0008, I = 75%). DES were associated with significantly lower rates of TLR than control at maximum follow-up (HR 0.48, 95% CI 0.33-0.68, < .0001; I = 11%). There was no statistical difference between DES versus control in rates of major limb amputation and mortality.
DES have superior primary patency and TLR rates with no difference in amputation and all-cause mortality rates compared with conventional endovascular therapies in patients with infrapopliteal PAD.
球囊血管成形术是有症状的腘下外周动脉疾病（PAD）的标准血管内治疗方法。然而，最近的试验研究了药物洗脱支架（DES）用于腘下PAD的有效性。
本研究调查了与标准血管内技术相比，DES在治疗腘下动脉疾病中的应用。
这是一项对9项近期随机对照试验的全面系统评价和荟萃分析。评估的主要临床结局是原发性通畅率。次要结局是靶病变血管重建（TLR）、大肢体截肢和全因死亡率。
共有945例患者符合纳入标准。在最长随访期时，发现接受DES治疗的患者原发性通畅率高于对照组（风险比[HR]2.17，95%置信区间[CI]1.58 - 2.97，P <.0001，I² = 62%）。在严重肢体缺血患者亚组中也观察到类似结果（HR 2.58，95%CI 1.49 - 4.49，P =.0008，I² = 75%）。在最长随访期时，DES与对照组相比，TLR发生率显著更低（HR 0.48，95%CI 0.33 - 0.68，P <.0001；I² = 11%）。DES与对照组在大肢体截肢率和死亡率方面无统计学差异。
在腘下PAD患者中，与传统血管内治疗相比，DES具有更高的原发性通畅率和TLR发生率，而在截肢率和全因死亡率方面无差异。
