An indirect comparison by Bayesian network meta-analysis of drug-coated devices versus saphenous vein graft bypass in femoropopliteal arterial occlusive disease.

Abstract

OBJECTIVE:

To compare the efficacy and safety between drug-coated devices (DCDs) and bypass surgery with saphenous vein graft (BSV) in femoropopliteal arterial occlusive disease.

METHODS:

A Bayesian network meta-analysis and indirect comparison were performed. Randomized controlled trials of BSV, bypass surgery with prosthetic graft, bare metal stents, endoluminal bypass (covered stent), percutaneous transluminal angioplasty, and DCDs treating femoropopliteal arterial occlusive disease were collected. The primary end point was target lesion revascularization/target vessel revascularization, and secondary end points were all-cause mortality, limb salvage, and early complications (PROSPERO registry number: CRD42019136530).

RESULTS:

Forty-two trials and 6867 patients were included. The comparison of DCDs and BSV revealed no significant difference in the 1-year target lesion revascularization/target vessel revascularization (DCDs vs BSV: odds ratio [OR], 0.60; 95% credible interval [CrI], 0.16-2.39). Total early complications from BSV were significantly higher than those from DCDs (DCDs vs BSV: OR, 0.14; 95% CrI, 0.05-0.45), and the main complications of BSV were not death related. There was also no significant difference in systemic early complications (DCDs vs BSV: OR, 0.19; 95% CrI, 0.00-7.82) and 1-year amputation rate (DCDs vs BSV: OR, 2.81; 95% CrI, 0.16-89.53). The 30-day (DCDs vs BSV: OR, 0.38; 95% CrI, 0.00-110.46), 1-year (DCDs vs BSV: OR, 0.96; 95% CrI, 0.24-3.29), 2-year (DCDs vs BSV: OR, 1.60; 95% CrI, 0.64-4.95), and 5-year all-cause mortality rates (DCDs vs BSV: OR, 2.05; 95% CrI, 0.92-4.39) showed no significant differences between DCDs and BSV, although there was a noticeable tendency toward significant results of a higher 5-year mortality rate.

CONCLUSIONS:

There is no significant difference between DCDs and BSV in short-term efficacy or short- and long-term mortality. Despite traditional BSV remaining the gold standard, DCDs provide a reasonable alternative therapy. In addition, the DCDs have a lower short-term morbidity associated with the procedure at the cost of the possible risk of higher long-term mortality. Clinical trials with more validity are required for a direct comparison between BSV and DCDs.

• Authors: Rui Zhang, Leng Ni, Rong Zeng, Zhichao Lai, Xiao Di, Zhewei Zhao, Zhibo Xie, Xuebin Wang, Baitao Ma, Changwei Liu
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 74 Issue 2 Pg. 478-486.e11 (08 2021) ISSN: 1097-6809 [Electronic] United States
• PMID: 33600930 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Chemical References

• Coated Materials, Biocompatible

Topics

• Adult
• Aged
• Aged, 80 and over
• Bayes Theorem
• Coated Materials, Biocompatible
• Drug-Eluting Stents
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Femoral Artery (diagnostic imaging, physiopathology, surgery)
• Humans
• Limb Salvage
• Male
• Middle Aged
• Network Meta-Analysis
• Peripheral Arterial Disease (diagnostic imaging, mortality, physiopathology, therapy)
• Popliteal Artery (diagnostic imaging, physiopathology, surgery)
• Postoperative Complications (etiology)
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Saphenous Vein (transplantation)
• Time Factors
• Treatment Outcome