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Circ Cardiovasc Interv. 2016 May;9(5):e003468. doi: 10.1161/CIRCINTERVENTIONS.115.003468.

Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease: Systematic Review and Meta-Analysis.

Author information

1
From the Department of Medicine, Metro Health Hospital, Wyoming, MI (J.A.M., S.M.F., L.J.D.-S., F.A.S.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.). jihad.mustapha@metrogr.org.
2
From the Department of Medicine, Metro Health Hospital, Wyoming, MI (J.A.M., S.M.F., L.J.D.-S., F.A.S.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.).

Abstract

BACKGROUND:

Contemporary outcomes of percutaneous transluminal angioplasty for the treatment of infrapopliteal atherosclerotic lesions are not well characterized. Hence, a systematic review and meta-analysis was performed to determine the safety and effectiveness of this approach in patients with advanced below-the-knee arterial disease.

METHODS AND RESULTS:

MEDLINE and EMBASE databases were searched for contemporary studies (2005-2015) on the effects of percutaneous transluminal angioplasty for the treatment of infrapopliteal lesions. A random effects meta-analysis model was used to analyze procedural (technical success, flow-limiting dissection, provisional stent placement) and long-term (primary patency, repeat revascularization, major amputation, all-cause mortality) outcomes. Ultimately, 52 studies encompassing 6769 patients with 9399 below-the-knee lesions were included in the analysis. Technical success was 91.1% (95% confidence interval [CI], 88.8-93.0), and the incidence of flow-limiting dissections and bailout stenting was 5.6% (95% CI, 3.2-9.8) and 9.1% (95% CI, 6.3-12.9), respectively. Outcomes at 1 year were primary patency, 63.1% (95% CI, 57.3-68.6); repeat revascularization, 18.2% (95% CI, 14.5-22.6); major amputation, 14.9% (95% CI, 12.3-18.0); and all-cause mortality, 15.1% (95% CI, 12.8-17.7). Significant heterogeneity and publication bias were observed for most percutaneous transluminal angioplasty outcomes.

CONCLUSIONS:

Contemporary studies of the use of percutaneous transluminal angioplasty as primary treatment for patients with infrapopliteal arterial disease reveal suboptimal procedural and 1-year clinical outcomes.

KEYWORDS:

angioplasty; meta-analysis; percutaneous; peripheral artery disease; peripheral vascular disease; systematic review

[Indexed for MEDLINE]

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