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Endovascular revasc...
Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis
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Koeckerling, D. (author)
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Raguindin, P. F. (author)
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Kastrati, L. (author)
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Bernhard, S. (author)
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Barker, J. (author)
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Centeno, A. C. Q. (author)
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Raeisi-Dehkordi, H. (author)
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Khatami, F. (author)
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Niehot, C. (author)
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Lejay, A. (author)
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Szeberin, Z. (author)
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Behrendt, C. A. (author)
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- Nordanstig, Joakim (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Muka, T. (author)
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Baumgartner, I. (author)
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(creator_code:org_t)
- 2023-01-31
- 2023
- English.
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In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 44:11, s. 935-950
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Abstract
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- Aims Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. Methods and results Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (>= 2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints. Conclusion Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Intermittent claudication
- Endovascular revascularization
- Drug-coated
- balloon
- Drug-eluting stent
- Atherectomy
- angioplasty
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Koeckerling, D.
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Raguindin, P. F.
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Kastrati, L.
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Bernhard, S.
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Barker, J.
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Centeno, A. C. Q ...
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show more...
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Raeisi-Dehkordi, ...
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Khatami, F.
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Niehot, C.
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Lejay, A.
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Szeberin, Z.
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Behrendt, C. A.
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Nordanstig, Joak ...
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Muka, T.
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Baumgartner, I.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Heart J ...
- By the university
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University of Gothenburg