Abstract：
OBJECTIVE: To evaluate the best endovascular treatment for de novo femoropopliteal lesions at long-term follow-up through network meta-analysis of randomized controlled trials.
METHODS: Medical databases were searched on September 17, 2023. 17 trials and 7 treatments were selected. Outcomes were primary patency, target lesion revascularization (TLR), major amputation and all-cause mortality at 3 and/or 5 years.
RESULTS: Regarding 3-year primary patency, drug-eluting stents (DES) was the best and better than balloon angioplasty (BA; odds ratio [OR], 4.96; 95% confidence interval [CI], 2.68-9.18), bare metal stents (BMS; OR, 2.81; 95% CI, 1.45-5.46), cryoplasty (OR, 6.75; 95% CI, 2.76-16.50), covered stents (CS; OR, 3.25; 95% CI, 1.19-8.87) and drug-coated balloons (DCB; OR, 2.04; 95% CI, 1.14-3.63). Regarding 5-year primary patency, DES was the best and better than BMS (OR, 2.34; 95% CI, 1.10-4.99). Regarding 3-year TLR, DES was the best and better than BA (OR, 0.24; 95% CI, 0.13-0.44). Regarding 5-year TLR, DES was the best and better than BA (OR, 0.20; 95% CI, 0.09-0.42) and balloon angioplasty with brachytherapy (OR, 0.21; 95% CI, 0.06-0.74). Regarding 3- and 5-year major amputation, DCB was the best. Regarding 3-year mortality, DES was the best and better than CS (OR, 0.09; 95% CI, 0.01-0.67).
CONCLUSIONS: DES was the best treatment regarding 3-year primary patency, TLR and mortality, and DCB was the best regarding major amputation. DES was the best treatment regarding 5-year TLR, and DCB was the best regarding primary patency and major amputation. DES and DCB should be given priority in treating femoropopliteal lesions.
METHODS: Medical databases were searched on September 17, 2023. 17 trials and 7 treatments were selected. Outcomes were primary patency, target lesion revascularization (TLR), major amputation and all-cause mortality at 3 and/or 5 years.
RESULTS: Regarding 3-year primary patency, drug-eluting stents (DES) was the best and better than balloon angioplasty (BA; odds ratio [OR], 4.96; 95% confidence interval [CI], 2.68-9.18), bare metal stents (BMS; OR, 2.81; 95% CI, 1.45-5.46), cryoplasty (OR, 6.75; 95% CI, 2.76-16.50), covered stents (CS; OR, 3.25; 95% CI, 1.19-8.87) and drug-coated balloons (DCB; OR, 2.04; 95% CI, 1.14-3.63). Regarding 5-year primary patency, DES was the best and better than BMS (OR, 2.34; 95% CI, 1.10-4.99). Regarding 3-year TLR, DES was the best and better than BA (OR, 0.24; 95% CI, 0.13-0.44). Regarding 5-year TLR, DES was the best and better than BA (OR, 0.20; 95% CI, 0.09-0.42) and balloon angioplasty with brachytherapy (OR, 0.21; 95% CI, 0.06-0.74). Regarding 3- and 5-year major amputation, DCB was the best. Regarding 3-year mortality, DES was the best and better than CS (OR, 0.09; 95% CI, 0.01-0.67).
CONCLUSIONS: DES was the best treatment regarding 3-year primary patency, TLR and mortality, and DCB was the best regarding major amputation. DES was the best treatment regarding 5-year TLR, and DCB was the best regarding primary patency and major amputation. DES and DCB should be given priority in treating femoropopliteal lesions.
摘要：
目的：通过对随机对照试验的网络荟萃分析，评估长期随访中新出现的股pop病变的最佳血管内治疗方法。
方法：于2023年9月17日检索了医学数据库。选择17项试验和7种治疗方法。结果是初级通畅，靶病变血运重建(TLR),严重截肢和3年和/或5年全因死亡率。
结果：关于3年的主要通畅性，药物洗脱支架（DES）是最好的，优于球囊血管成形术（BA；优势比[OR]，4.96；95%置信区间[CI]，2.68-9.18),裸露金属支架(BMS;或,2.81；95%CI，1.45-5.46)，冷冻成形术（或，6.75；95%CI，2.76-16.50），覆膜支架（CS；或，3.25；95%CI，1.19-8.87）和药物涂层球囊（DCB；或，2.04；95%CI，1.14-3.63）。关于5年的初级通畅，DES是最好的，比BMS更好（或，2.34；95%CI，1.10-4.99）。关于3年TLR，DES是最好的，也比BA好(或者，0.24；95%CI，0.13-0.44）。关于5年TLR，DES是最好的，也比BA好(或者，0.20；95%CI，0.09-0.42）和近距离放射治疗球囊血管成形术（OR，0.21；95%CI，0.06-0.74）。关于3年和5年的严重截肢手术，DCB是最好的。关于3年死亡率，DES是最好的，也比CS好(或者，0.09；95%CI，0.01-0.67）。
结论：DES是3年原发性通畅的最佳治疗方法，TLR和死亡率，DCB是关于大截肢最好的。DES是5年TLR的最佳治疗方法，DCB在主要通畅性和主要截肢方面是最好的。DES和DCB在治疗股pop病变时应优先考虑。
方法：于2023年9月17日检索了医学数据库。选择17项试验和7种治疗方法。结果是初级通畅，靶病变血运重建(TLR),严重截肢和3年和/或5年全因死亡率。
结果：关于3年的主要通畅性，药物洗脱支架（DES）是最好的，优于球囊血管成形术（BA；优势比[OR]，4.96；95%置信区间[CI]，2.68-9.18),裸露金属支架(BMS;或,2.81；95%CI，1.45-5.46)，冷冻成形术（或，6.75；95%CI，2.76-16.50），覆膜支架（CS；或，3.25；95%CI，1.19-8.87）和药物涂层球囊（DCB；或，2.04；95%CI，1.14-3.63）。关于5年的初级通畅，DES是最好的，比BMS更好（或，2.34；95%CI，1.10-4.99）。关于3年TLR，DES是最好的，也比BA好(或者，0.24；95%CI，0.13-0.44）。关于5年TLR，DES是最好的，也比BA好(或者，0.20；95%CI，0.09-0.42）和近距离放射治疗球囊血管成形术（OR，0.21；95%CI，0.06-0.74）。关于3年和5年的严重截肢手术，DCB是最好的。关于3年死亡率，DES是最好的，也比CS好(或者，0.09；95%CI，0.01-0.67）。
结论：DES是3年原发性通畅的最佳治疗方法，TLR和死亡率，DCB是关于大截肢最好的。DES是5年TLR的最佳治疗方法，DCB在主要通畅性和主要截肢方面是最好的。DES和DCB在治疗股pop病变时应优先考虑。
