Comparison of the Efficacy and Safety of Endovascular Treatment for Isolated Popliteal Lesions in Peripheral Artery Disease: A Network Meta-Analysis.

BACKGROUND

This study employed a network meta-analysis to systematically compare the efficacy and safety of different endovascular interventions for treating isolated popliteal lesions in peripheral arterial disease.

METHODS

A systematic search was conducted across the Cochrane Library, Embase, and PubMed databases (2010-2025), identifying 11 studies involving 4,179 patients. A network meta-analysis was performed using R software to compare the efficacy of percutaneous transluminal angioplasty (PTA), drug-coated balloon (DCB), atherectomy, and stenting. Primary outcomes included all-cause mortality, major amputation rate, and overall amputation rate, while secondary outcomes comprised primary patency rate, freedom from target lesion revascularization, and technical success rate.

RESULTS

In terms of 1-year all-cause mortality, atherectomy demonstrated significantly lower rates compared to both the PTA group (odds ratio [OR] = 0.61, 95% credible interval [CrI]: 0.41-0.87) and the stenting group (OR = 0.66, 95% CrI: 0.44-0.97). Regarding 1-year major amputation and overall amputation rates, stenting significantly outperformed PTA (OR = 0.64 and 0.65, respectively), while no significant differences were observed between atherectomy, DCB, and PTA groups. For 1-year primary patency rates, both atherectomy and stenting significantly outperformed PTA (OR = 2.21 and 2.23, respectively). Furthermore, the technical success rate of atherectomy was significantly higher than that of the other 3 interventions.

CONCLUSION

Atherectomy demonstrates advantages in reducing all-cause mortality and improving technical success rates, while stenting yields superior outcomes in lowering amputation risk. Both atherectomy and stenting significantly outperform PTA in achieving 1-year primary patency rates. Although DCB demonstrates superior efficacy and safety compared with plain PTA, the differences did not reach statistical significance.