[Systematic review of primary stenting for arteriosclerotic occlusion in below-the-knee arteries].
OBJECTIVE
To evaluate the clinical value of primary stenting for treating peripheral arterial diseases in below-the-knee arteries by comparing to percutaneous transluminal angioplasty (PTA).


METHODS
PubMed, ScienceDirect, Embase, and CBM databases were searched for relevant articles. Based on the different types of stents, we divided the primary stent group into the bare metal stent(BMS) group and drug-eluting stent(DES) group. The outcome measures were immediate technical success, freedom from target vessel revascularization (TVR-free) rate and limb salvage.


RESULTS
Finally, 14 studies (published between 2001 and 2012) satisfying the inclusion criteria were identified. A total of 3 278 patients and 3 699 limbs constituted our final study population. The technical success rate of PTA was 90.95% (95% confidence interval (CI) 86.25%-94.15%). Only one study reported a technical failure of 4% (5/118) in the primary stent group. There were no significant differences in the 1-year primary patency and TVR-free rates between the PTA group and BMS groups (P > 0.05 and P > 0.05), respectively. The pooled estimates of 1-year primary patency and TVR-free rate in DES group were 85.05% (95%CI 79.95%-89.02%) and 90.52% (95%CI 83.68%-94.67%), respectively, which were better than those of the BMS (P < 0.001) and PTA groups (P < 0.001). The pooled estimate of 1-year limb salvage in the PTA, BMS, and DES groups was 88.41% (95%CI 84.53%-91.43%), 94.41% (95%CI 89.52%-97.1%), and 96.81% (95%CI 94.04%-98.32%), respectively. The BMS and DES groups had higher limb salvage rates than the PTA group (P < 0.001 for both comparisons). The rates of severe complications were low both in the PTA and primary stent groups. Although the influence analysis showed rather robust results, the heterogeneity was quite high and they were not adjusted for confounding variables.


CONCLUSIONS
Primary BMS implantation had no advantage over PTA in reducing restenosis or revascularization for infrapopliteal disease. Primary DES implantation seems to be a promising treatment for focal infrapopliteal lesions.
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Xinrui
X
Yang
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China. Email: luxinwu@aliyun.com.
Xinwu
X
Lu
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Kaichuang
K
Ye
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Jinbao
J
Qin
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Lijia
L
Huang
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Zhiyou
Z
Peng
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Fukang
F
Yuan
Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, and Vascular Center of Shanghai Jiaotong University, Shanghai 200025, China.
Mi'er
M
Jiang
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D015607:Stents; D016896:Treatment Outcome