title: A network meta-analysis of randomized controlled trials comparing treatment modalities for de novo superficial femoral artery occlusive lesions.
abstract: BACKGROUND
  Treatment of superficial femoral artery (SFA) lesions remains challenging. We conducted a network meta-analysis of randomized controlled trials aiming to explore the efficacy of treatment modalities for SFA "de novo" lesions.
  
  
  METHODS
  Eleven treatments for SFA occlusive disease were recognized. We used primary patency and binary restenosis at 12-month follow-up as proxies of efficacy for the treatment of SFA lesions.
  
  
  RESULTS
  A total of 33 studies (66 study arms; 4659 patients) were deemed eligible. In terms of primary patency, odds ratios (ORs) with 95% confidence intervals (CIs) were statistically significantly higher in drug-eluting stent (DES; OR, 10.05; 95% CI, 3.22-31.39), femoropopliteal bypass surgery (BPS; OR, 7.15; 95% CI, 2.27-22.51), covered stent (CS; OR, 3.56; 95% CI, 1.33-9.53), and nitinol stent (NS; OR, 2.83; 95% CI, 1.42-5.51) compared with balloon angioplasty (BA). The rank order from higher to lower primary patency in the multidimensional scaling was DES, BPS, NS, CS, drug-coated balloon, percutaneous transluminal angioplasty with brachytherapy, stainless steel stent, cryoplasty (CR), and BA. Combination therapy of NS with CR and drug-coated balloon were the two most effective treatments, followed by NS, CS, percutaneous transluminal angioplasty with brachytherapy, cutting balloon, stainless steel stent, BA, and CR in terms of multidimensional scaling values for binary restenosis.
  
  
  CONCLUSIONS
  DES has shown encouraging results in terms of primary patency for SFA lesions, whereas BPS still maintains its role as a principal intervention. On the contrary, BA and CR appear to be less effective treatment options.
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece. Electronic address: kostas.antonopoulos@gmail.com.
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Spyridon N
authors.initials: SN
authors.lastname: Mylonas
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.affiliation: Department of Epidemiology and Biostatistics, University of Athens, Athens, Greece.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Sfyroeras
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Lazaris
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: John D
authors.initials: JD
authors.lastname: Kakisis
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Spyros N
authors.initials: SN
authors.lastname: Vasdekis
mesh_terms: D000497:Alloys; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001918:Brachytherapy; D002317:Cardiovascular Agents / Q000008:administration & dosage; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D017679:Cryotherapy; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D016017:Odds Ratio; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation
chemical_list: D000497:Alloys; D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; C013616:nitinol