Atherectomy Combined with Balloon Angioplasty versus Balloon Angioplasty Alone for de Novo Femoropopliteal Arterial Diseases: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Eur J Vasc Endovasc Surg. 2021 Jul;62(1):65-73. doi: 10.1016/j.ejvs.2021.02.012. Epub 2021 Jun 8.

Abstract

Objective: The efficacy and cost effectiveness of atherectomy for femoropopliteal (FP) arterial diseases have not been determined yet. A systematic review and meta-analysis were performed to compare the efficacy and safety between atherectomy combined with balloon angioplasty (BA) and BA alone for patients with de novo FP steno-occlusive lesions.

Methods: The Cochrane Library, Medline, and Embase were used to search for studies evaluating outcomes of atherectomy combined with BA compared with BA alone in FP arterial diseases from inception to July 2020. The methodological quality of the included studies was evaluated with the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the level of evidence for each outcome. The fixed effects model was chosen to combine the data when I2 < 50%; otherwise, the random effects model was used. Subgroup and sensitivity analyses were performed to further analyse the results.

Results: Four RCTs were included. The meta-analysis showed that atherectomy combined with BA was associated with improved technical success rate (risk ratio [RR] 0.22, 95% confidence interval [CI] 0.13-0.38, p < .001; I2 = 0; high quality), reduced bailout stenting (RR 0.15, 95% CI 0.07-0.32, p < .001; I2 = 16%; high quality), and flow limiting dissection (RR 0.24, 95% CI 0.13-0.47, p < .001; I2 = 0; high quality). No statistically significant difference was found in target lesion revascularisation (TLR), primary patency, mortality, major adverse event (MAE), or ankle brachial index (ABI) after one year follow up.

Conclusion: Compared with BA alone, atherectomy combined with BA may not improve primary patency, TLR, mortality rate, or ABI, but may reduce the need for bailout stenting and the incidence of flow limiting dissection and increase the technical success rate in FP arterial diseases. More studies are warranted to further confirm the conclusion.

Keywords: Angioplasty; Atherectomy; Femoropopliteal artery; Meta-analysis; Peripheral artery disease; Systematic review.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / statistics & numerical data*
  • Ankle Brachial Index
  • Aortic Dissection / epidemiology*
  • Aortic Dissection / etiology
  • Aortic Dissection / prevention & control
  • Aortic Dissection / surgery
  • Atherectomy / adverse effects
  • Atherectomy / statistics & numerical data*
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / statistics & numerical data
  • Femoral Artery / surgery*
  • Follow-Up Studies
  • Humans
  • Peripheral Arterial Disease / complications
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Randomized Controlled Trials as Topic
  • Stents / statistics & numerical data
  • Treatment Outcome
  • Vascular Patency