REVIEW  PERIPHERAL ARTERIAL DISEASE Editor’s choice • Free access

International Angiology 2021 February;40(1):42-51

DOI: 10.23736/S0392-9590.20.04462-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

A systematic review and meta-analysis of bioresorbable vascular scaffolds for below-the-knee 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 DE VRIES ⁷, Çağdaş ÜNLÜ ¹

¹ Department of Vascular Surgery, Northwest Clinics, 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 Hospital, Sydney, Australia; ⁶ Department of Vascular Surgery, University Medical Center (UMC) Utrecht, Utrecht, the Netherlands; ⁷ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen (UMCG), Groningen, the Netherlands

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: Blood vessels; Ischemia; Arteries; Meta-analysis; Systematic review