Drug-eluting stents for the treatment of complex femoro-popliteal disease: a systematic review and meta-analysis.

Endovascular methods have emerged as an appealing alternative to bypass for the treatment of patients not suitable for surgery. Drug eluting stents (DES) have been developed to address the limitations of angioplasty and stenting. There is a paucity of data in the literature on their performance for the treatment of patients with long femoro-popliteal segment lesions. We aimed to analyze the evidence supporting the use of DES in patients with complex femoro-popliteal disease. A systematic review and meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. A total of 1255 potentially relevant articles were initially selected. After reviewing at title or abstract level, 22 articles were read in full and 10 were included. These studies reported on the use of DES for 1539 patients. In all studies the DES that was employed was a paclitaxel-eluting stent (Zilver PTX, Cook Medical; Bloomington, IN, USA). Average lesion length ranged from 114 mm to 400 mm. The pooled technical success rate was 0.964 (95% confidence interval [CI]: 0.936-0.980). The pooled estimate of limb loss at 12 months was 0.019 (95% CI: 0.012-0.030), stent fracture at 12 months was 0.035 (95% CI: 0.007-0.155), primary patency at 12 months was 0.705 (95% CI: 0.576-0.807) and secondary patency at 12 months was 0.898 (95% CI: 0.815-0.946). The short-term outcomes of DES for TASC C & D femoro-popliteal lesions are encouraging. Caution is advised in extrapolating the results of the included studies due to the large heterogeneity and lack of reporting of subgroup specific outcomes.