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International Angiology 2020 Oct 21

DOI: 10.23736/S0392-9590.20.04462-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

A systematic review and meta-analysis of bioresorbable vascular scaffolds for below-theknee arterial disease

Jetty IPEMA 1 , Steven KUM 2, Eline HUIZING 1, Michiel A. SCHREVE 1, Ramon L. VARCOE 3, 4, 5, Constantijn E. HAZENBERG 6, Jean-Paul P.M. de VRIES 7, Çağdaş ÜNLÜ 1

1 Department of Vascular Surgery, Northwest Clinics Alkmaar, Alkmaar, The Netherlands; 2 Department of Surgery, Changi General Hospital, Singapore, Singapore; 3 Department of Surgery, Prince of Wales Hospital, Sydney, Australia; 4 Faculty of Medicine, University of New South Wales, Sydney, Australia; 5 The Vascular Institute, Prince of Wales, Sydney, Australia; 6 Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands; 7 Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands


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INTRODUCTION: Different types of bioresorbable vascular scaffolds (BVSs) have been developed and used in below-the-knee (BTK) arterial diseases. This is the first study reviewing and analyzing the literature on BVS treatment for BTK arterial disease.
EVIDENCE ACQUISITION: MEDLINE; Embase; and Cochrane were searched for studies published until October 21; 2019. The search; study selection; quality assessment; and data extraction were performed by 2 authors independently. Articles that studied the treatment of BTK arterial disease by using BVSs were eligible. Exclusion criteria were studies with a variant design (e.g.; case reports <5 patients); non-BTK indications for BVS use; and nonhuman studies. Primary endpoint was 12-month primary patency. Secondary endpoints were 12-month freedom from clinically-driven target lesion revascularization (CD-TLR); limb salvage; survival; and amputation-free survival (AFS). Study quality was assessed by the Methodological Index for Non-randomized Studies score.
EVIDENCE SYNTHESIS: Five studies representing 155 patients with 160 treated limbs met the inclusion criteria. Pooled 12-month primary patency per limb was 90% (143/160; 95% confidence interval [CI]: 0.84-0.95); freedom from CD-TLR 96% (124/130; 95% CI: 0.91-0.99); limb salvage rate 97% (156/160; 95% CI: 0.94-1.00); survival rate 90% (112/125; 95% CI: 0.82-0.96); and AFS rate 89% (110/125; 95% CI: 0.81-0.94). Subgroup analyses of included Absorb BVS studies showed similar results. All studies were assessed as moderate quality.
CONCLUSIONS: This meta-analysis of case series showed good 12-month patency and clinical results with BVSs for BTK arterial disease; even in patients with multimorbidity and short but complex lesions. These results encourage a revival of this scaffold.


KEY WORDS: Bioresorbable vascular scaffold; Below the knee; Chronic limb-threatening ischemia; Meta-analysis; Systematic review

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