F-18 | Comparison of the Safety and Efficacy of Endovascular Interventions for the Treatment of Superficial Femoral Artery Disease: A Network Meta-analysis

For clinical decision-making in superficial femoral artery (SFA) disease, it is important to understand the relative safety and efficacy of various endovascular treatment options. We completed a systematic literature search of PubMed in January 2023 to identify RCTs comparing endovascular interventions for the treatment of SFA disease (CRD42022377373). The primary endpoints were technical success and 12-month primary patency. Secondary endpoints included 12-month target lesion revascularization (TLR), mortality, and change in Rutherford score. A network meta-analysis was conducted to compare the odds ratios (OR) for these outcomes among 12 endovascular treatment modalities. In total, 579 studies were screened for eligibility, with 57 studies (N = 5765) meeting inclusion criteria. Mean age was 68.4 years, 41.4% of patients had diabetes mellitus, 18.3% had CLTI, while 81.3% had a de novo lesion. A mean of 1.2 lesions were treated per patient. Technical success was superior for CSG (endovascular intervention abbreviations located in the figure legend), BMS, and A+DCB compared to PTA, while A+DCB and CSG were superior to DCB. All interventions except brachytherapy alone had superior primary patency vs PTA (Fig). There were no significant differences in 12-month mortality. All interventions except L+DCB, PTA+A, and CBA/A were superior to PTA with regard to TLR, while only DCB, DES, and BMS were better than PTA at improving Rutherford classification. In SFA disease, PTA alone is inferior to other endovascular techniques. A comparison of other endovascular techniques will be valuable for clinical decision-making.