Open surgical thrombendarterectomy versus endovascular treatment in occlusive processes of the femoral artery bifurcation

• Verfasst von: Hoffmann-Wieker, Carola Marie [VerfasserIn]
• Verfasst von: Ronellenfitsch, Ulrich [VerfasserIn]
• Verfasst von: Gomes dos Santos Ferreira Rebelo, Artur Luis [VerfasserIn]
• Verfasst von: Görg, Nadine [VerfasserIn]
• Verfasst von: Schwarzer, Guido [VerfasserIn]
• Verfasst von: Ballotta, Enzo [VerfasserIn]
• Verfasst von: Goueffic, Yann [VerfasserIn]
• Verfasst von: Böckler, Dittmar [VerfasserIn]
• Titel: Open surgical thrombendarterectomy versus endovascular treatment in occlusive processes of the femoral artery bifurcation
• Titelzusatz: a systematic review and meta-analysis of aggregate data and individual patient data
• Verf.angabe: Carola Marie Hoffmann-Wieker, Ulrich Ronellenfitsch, Artur Rebelo, Nadine Görg, Guido Schwarzer, Enzo Ballotta, Yann Gouëffic, Dittmar Böckler
• Jahr: 2022
• Umfang: Illustrationen
• Umfang: 19 S.
• Fussnoten: Gesehen am 14.04.2023
• Titel Quelle: Enthalten in: Deutsches Ärzteblatt international
• Ort Quelle: Köln : Dt. Ärzte-Verl., 2006
• Jahr Quelle: 2022
• Band/Heft Quelle: 119, 47 (2022), Seite 803-809, I-XII
• ISSN Quelle: 1866-0452
• DOI: doi:10.3238/arztebl.m2022.0331
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: disease
• Sach-SW: endarterectomy
• Sach-SW: hybrid
• Sach-SW: lesions
• Sach-SW: management
• Sach-SW: outcomes
• Sach-SW: repair
• Sach-SW: stent
• K10plus-PPN: 1842675044

Abstract

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.