Stent or No Stent for Endovascular Therapies Done in Common Femoral Artery Atherosclerotic Stenosis: A Meta-analysis.

Changal, Khalid

Background
Common femoral artery (CFA) is a common location for atherosclerotic disease.Fear of stent fracture from mobility due to being near the hip joint, compromise of profunda femoral artery flow and compromise of future vascular access remain the most common perceived reasons for avoidance of stenting in this segment. This meta-analysis was done to compare outcomes of endovascular therapy with routine stenting (EVT-RS) with endovascular therapy with selective stenting (EVT-SS).

Methods
We included studies that treated CFA stenosis with EVT-RS or EVT SS. We studies primary patency (PP) and target lesion revascularization (TLR) at 1 year, mortality, local complications and amputations. Proportional meta-analysis was done using a random-effect model. If confidence intervals of results for an outcome do not overlap statistical significance is determined.

Results
Seven EVT-RS (289 patients, 306 limbs) and 8 EVT-SS (646 patients, 678 limbs) studies met the inclusion criteria. A total of 330 CFA stents were placed in EVT-RS group (71.8% self-expanding). In EVT-SS group, 123 CFA stents were placed (86.4% self- expanding). Both groups were comparable. PP at 1 year in EVT-RS was 84% (95% CI 0.75-0.92) and EVT-SS was 78% (95% CI 0.69-0.85). TLR at 1 year in EVT-RS was 8% (95% CI 0.04-0.13) and in EVT-SS was 19% (95% CI 0.14-0.23). This result has statistical significance. The mortality at 30 days for EVT-RS was 0.8% (95% CI 0.001-0.02) and EVT-SS was 1% (95% CI 0.004, 0.02). The pooled local complications for EVT-RS was 5% (95% CI 0.02-0.1) and for EVT-SS was 7%(95% CI 0.03-0.1). The rate of amputations after EVT-RS was 3% (95% CI 0.01-0.06) and EVT-SS was 4.02% (95% CI 0.02-0.6). CIs for mortality, local complications and amputations overlap and thus are not statistically significant. Stent fractures were reported in only 6 (1.8%) in EVT-RS and none in EVT-SS. Twenty-four stents in EVT-RS and 2 stents in EVT-SS were re-punctured for vascular access without any complications.

Conclusions
EVT-RS for CFA stenosis is associated with better one-year TLR rates. Stent fractures in CFA location are not common with the current design stents. Re-puncture of a stented CFA is less likely to be associated with complications.