Open surgical thrombendarterectomy versus endovascular treatment in occlusive processes of the femoral artery bifurcation: a systematic review and meta-analysis of aggregate data and individual patient data
Background: The standard treatment of occlusive processes of the femoral artery bifurcation is thrombendarterectomy (TEA). Endovascular techniques (ENDO) have recently been put forward as a potential alternative. It is unclear so far which modality yields better outcomes with respect to long-term re...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
2022
|
| In: |
Deutsches Ärzteblatt
Year: 2022, Volume: 119, Issue: 47, Pages: 803-809, 1-12 |
| ISSN: | 1866-0452 |
| DOI: | 10.3238/arztebl.m2022.0331 |
| Online Access: | Resolving-System, kostenfrei, Volltext: https://doi.org/10.3238/arztebl.m2022.0331 Verlag, kostenfrei, Volltext: https://www.aerzteblatt.de/int/archive/article/228552 
|
| Author Notes: | Carola Marie Hoffmann-Wieker, Ulrich Ronellenfitsch, Artur Rebelo, Nadine Görg, Guido Schwarzer, Enzo Ballotta, Yann Gouëffic, Dittmar Böckler |
| Summary: | Background: The standard treatment of occlusive processes of the femoral artery bifurcation is thrombendarterectomy (TEA). Endovascular techniques (ENDO) have recently been put forward as a potential alternative. It is unclear so far which modality yields better outcomes with respect to long-term revascularization and periprocedural complications.Method: Multiple databases were systematically searched for pertinent publications (publication date November 1965 to February 2022). From the included studies, in-dividual patient data (IPD) were requested. Aggregate data (AD) were used when no IPD were available. Primary and secondary patency (PP and SP), perioperative morbidity/mortality, and further endpoints were determined separately for TEA and ENDO and compared with each other. AD for each modality were summarized in meta-analyses. Time-to-event analyses and comparative meta-analyses with PP as primary endpoint were carried out using IPD.Results: 42 studies (3 IPD, 39 AD; 27 TEA, 12 ENDO, 3 comparisons of TEA versus ENDO) were included. In the combined meta-analysis of IPD and AD, PP for TEA was 97% at 6 months and 92% at 12 months, while PP for ENDO was 84% at 6 months and 85% at 12 months. The differences were not statistically significant. The comparative meta-analysis regarding PP did not reveal any significant differences either (TEA versus ENDO: HR 0.30 [0.06; 1.48]). SP at 12 months was 97% (TEA) and 93% (ENDO). The periprocedural morbidity was 16% for TEA and 9% for ENDO.Conclusion: In light of a higher PP, even without formal statistical proof of superior-ity, TEA can still be considered the standard treatment for occlusive processes of the femoral artery bifurcation. |
|---|---|
| Item Description: | Gesehen am 14.04.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1866-0452 |
| DOI: | 10.3238/arztebl.m2022.0331 |