title: Contemporary systematic review and meta-analysis of early outcomes with percutaneous treatment for infrapopliteal atherosclerotic disease.
abstract: OBJECTIVE
  The need for specialty devices to improve the technical outcome of endovascular interventions is dependent on the rate of early failure in such procedures. This meta-analysis assessed procedural outcomes of such interventions to elucidate the rate of early procedural failures and the need for such specialty devices.
  
  
  METHODS
  MEDLINE and EMBASE were searched for contemporary studies (2000-2012) reporting procedural or short-term outcomes for revascularization of infrapopliteal atherosclerotic lesions. A random-effects metaanalysis was performed, which included post hoc comparisons among treatment groups.
  
  
  RESULTS
  A total of 42 studies with 52 treatment arms representing 3,660 unique patients were included. Technical success rates were higher with bare metal stents (BMSs; 98.6%) than with atherectomy (92.2%; P < .05) or percutaneous transluminal angioplasty (PTA; 91.2%; P = .01), and higher with drug-eluting stents (DESs) than with PTA (P < .001). DES use had higher primary patency rates than atherectomy (P < .05), BMS use (P < .001), and PTA (P < .01). The 30-day rate of target lesion revascularization was significantly higher with PTA (8.1%) than with BMSs (2.2%; P < .05) and DESs (1.1%; P < .05). Thirty-day rates of major unplanned amputation (range, 1.5%-4.4%) and mortality (range, 0.9%-3.3%) were comparable among treatment groups. Significant heterogeneity among studies was noted for most PTA outcomes. Publication bias was evident for most PTA and DES outcomes.
  
  
  CONCLUSIONS
  Early failure of percutaneous therapies in patients with infrapopliteal atherosclerotic lesions is device- and technique-dependent. Specialty devices designed to reduce technical failure rates may therefore be of benefit in this selected group of patients. Study results are confounded by inconsistent data reporting, heterogeneity of treatment effects, and publication bias.
authors.affiliation: Vascular and Interventional Specialists of Orange County, Heart and Vascular Center, St. Joseph Hospital, Orange, CA 92868. Electronic address: mrazavi@pacbell.net.
authors.forename: Mahmood K
authors.initials: MK
authors.lastname: Razavi
authors.affiliation: Metro Heart and Vascular, Wyoming, Michigan.
authors.forename: Jihad A
authors.initials: JA
authors.lastname: Mustapha
authors.affiliation: Miller Scientific Consulting, Asheville, North Carolina.
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008670:Metals; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency
chemical_list: D008670:Metals