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Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. Should You Be Sceptical?

DOI: 10.4236/ss.2019.107026, PP. 235-254

Keywords: Femoral Artery, Stent (Nitinol, Drug-Eluting, Covered), Percutaneous Balloon Angioplasty, Drug Eluting Balloons, Randomised Controlled Trials, Meta-Analyses, Intermittent Claudication, Critical Limb Ischemia, Patency, Clinical Benefit

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Abstract:

A narrative review of the data provided by Randomised Controlled clinical trials and meta-analyses was undertaken to assess how much reliance a clinician could place on these in selecting a treatment for patients with disease of the Femoral artery. An attempt was made to detect and review every clinical trial and meta-analysis published on treatments relating to disease of the femoral artery but not relating to drug treatment. Disease of the femoral artery in >65 years age group occurs in approximately 20% of the population but symptomatology was present in <2%. Associated morbidity was high and the 5-year mortality rate was >40%. In almost all trials the predominant (>90%) indication for treatment was intermittent claudication. In this setting, clinical benefit was limited and did not extend beyond 12 months. Mortality, from co-morbidities was high. The Basil Trial was the only one to examine intervention for critical limb ischemia. The results for Bypass surgery and Percutaneous transarterial balloon angioplasty (PTA) were equivalent. There is little evidence to support the use of PTA or stenting other than in the treatment of patients with critical limb ischemia.

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