PMID- 36062761 OWN - NLM STAT- MEDLINE DCOM- 20240314 LR - 20240411 IS - 1545-1550 (Electronic) IS - 1526-6028 (Print) IS - 1526-6028 (Linking) VI - 31 IP - 2 DP - 2024 Apr TI - Vessel Preparation in Infrapopliteal Arterial Disease: A Systematic Review and Meta-Analysis. PG - 191-202 LID - 10.1177/15266028221120752 [doi] AB - PURPOSE: Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore, different vessel preparation devices have been developed to contribute to better peri- and postprocedural outcomes. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug-coated balloon (DCB) angioplasty with POBA or DCB alone in infrapopliteal arterial disease. METHODS: Medline, EMBASE, and Cochrane databases were searched for studies published between 2000 and 2022 assessing the value of adjunctive vessel preparation in infrapopliteal arterial disease. The primary outcomes were 12-month primary patency and limb salvage. RESULTS: A total of 1685 patients with 1913 lesions were included in 11 POBA studies. Methodological quality was assessed as poor to moderate in these studies. Only 2 studies with 144 patients assessed vessel preparation in conjunction with DCB angioplasty. These randomized trials were assessed as high quality and found no significant benefit of adjunctive atherectomy to DCB angioplasty. The pooled Kaplan-Meier estimates of 12-month primary patency and limb salvage in the POBA studies were 67.8% and 80.9% for POBA, 62.1% and 86.4% for scoring balloons, 67.9% and 79.6% for mechanical atherectomy (MA), and 79.7% and 82.6% for laser atherectomy, respectively. Within the pooled data only scoring balloons and MA demonstrated significantly improved 12-month limb salvage compared to POBA. CONCLUSIONS: Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and MA. However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. CLINICAL IMPACT: Infrapopliteal arterial disease is associated with chronic limb-threatening ischemia (CLTI) and generally complex to treat due to small vessel diameter, long lesion length, multilevel disease and severe calcification. A wide range of vessel preparation devices have been developed to contribute to improved peri- and postprocedural outcomes in these complex lesions. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug coated balloon (DCB) angioplasty with POBA or DCB angioplasty alone in infrapopliteal arterial disease. Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and mechanical atherectomy (MA). However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. FAU - Nugteren, Michael J AU - Nugteren MJ AUID- ORCID: 0000-0003-2154-4077 AD - Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. AD - Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. FAU - Welling, Rutger H A AU - Welling RHA AUID- ORCID: 0000-0001-6854-2277 AD - Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. FAU - Bakker, Olaf J AU - Bakker OJ AD - Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. FAU - Unlu, Cagdas AU - Unlu C AD - Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. FAU - Hazenberg, Constantijn E V B AU - Hazenberg CEVB AD - Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20220904 PL - United States TA - J Endovasc Ther JT - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists JID - 100896915 RN - 0 (Coated Materials, Biocompatible) SB - IM MH - Humans MH - Femoral Artery MH - Popliteal Artery MH - *Peripheral Arterial Disease/therapy MH - Risk Factors MH - Treatment Outcome MH - *Angioplasty, Balloon MH - Coated Materials, Biocompatible MH - Vascular Patency PMC - PMC10938478 OTO - NOTNLM OT - atherectomy OT - below the knee OT - infrapopliteal OT - scoring balloons OT - tibial OT - vessel preparation COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2022/09/06 06:00 MHDA- 2024/03/14 06:47 PMCR- 2024/03/14 CRDT- 2022/09/05 06:43 PHST- 2024/03/14 06:47 [medline] PHST- 2022/09/06 06:00 [pubmed] PHST- 2022/09/05 06:43 [entrez] PHST- 2024/03/14 00:00 [pmc-release] AID - 10.1177_15266028221120752 [pii] AID - 10.1177/15266028221120752 [doi] PST - ppublish SO - J Endovasc Ther. 2024 Apr;31(2):191-202. doi: 10.1177/15266028221120752. Epub 2022 Sep 4.