Meta-Analysis Comparing Endovascular Treatment Modalities for Femoropopliteal Peripheral Artery Disease

Abstract Endovascular interventions are commonly utilized for treatment of femoropopliteal peripheral artery disease. The relative efficacy of these interventions remains unclear. A Bayesian network meta-analysis was performed comparing 5 endovascular treatment modalities: balloon angioplasty (BA), bare metal stent (BMS), covered stent (CS), drug coated balloon (DCB), drug eluting stent (DES) for femoropopliteal peripheral artery disease. The primary efficacy endpoints were freedom from target lesion revascularization (TLR) and primary patency at 12 months. BA was the reference treatment. Twenty-two trials including 4381 participants provided data on TLR. Sixteen trials including 3691 participants provided data on primary patency. Point estimates for DCB suggested that it was the most efficacious treatment for freedom from TLR (OR: 4.23; 95% CrI: 2.43-7.66) followed by CS (OR: 3.65; 95% CrI: 1.11-12.55), DES (OR: 2.64; 95% CrI: 0.72-9.77) and BMS (OR: 2.3; 95% CrI: 1.11-4.76). Similarly, point estimates for primary patency were highest with DES (OR: 8.93; 95% CrI: 3.04, 27.14) followed by CS (OR: 3.91; 95% CrI: 1.18, 13.84), DCB (OR: 3.32; 95% CrI: 1.8, 6.25) and BMS (OR: 3.5; 95% CrI: 1.58, 7.99). In conclusion, DCB has the lowest need for target lesion revascularization while DES has the highest primary patency rate. DCB, CS, and BMS were associated with significant reductions in TLR compared to BA, while DCB, DES, CS, and BMS were associated with significantly improved primary patency compared to BA.