better treatment option in chronic superficial femoral artery occlusive disease: comparison of methods (meta-analysis)

Introduction: the objective is to evaluate the frequency of primary obstruction events (pro) during one-year follow-up after performing excisional atherectomy with the silverhawk/turbohawk atherectomy device (s/th) or remote superficial femoral artery endarterectomy (rsfae) in patients with the chronic superficial femoral artery occlusive disease (сsfaod). methods: we included all randomized clinical trials (rcts) and not-rcts concerning the treatment of patients with сsfaod after s/th and rsfae without duration. results: twenty-nine items (1990-2017) were discovered; 27 articles on the levels of evidence were included in qualitative synthesis; 9 studies (meta-analysis) were included in quantitative synthesis. the results of 2762 patients’ treatment were summed up in our analysis (1422 patients s/th; 1340 patients rsfae). all included reports were at low risk of bias. according to the criterion “frequency of pro” during one-year follow-up, the pooled hazard ratios indicate significant favours of s/th if compared it with rsfae (hr= 0.66 (0.57 to 0.76, p < 0.00001), i2 = 9%). conclusion: our study showed that s/th with the spiderfx device (distal embolic protection) are safe and effective treatment option for short lesion (<15 cm) in patients with сsfaod. the usage of s/th methods significantly reduced number of pro if compared it with rsfae. in long-segment lesion (>15 cm) in patients with сsfaod, rsfae may be considered better than an endovascular procedure. but still it is necessary to conduct well-planned randomized studies to determine effectiveness and safety of the compared methods (s/th and rsfae) in patients with long-segment lesion (>15 cm).