Evidence- and guideline-based perspectives on the evolution of endovascular therapy for lower extremity peripheral artery disease: A critical analysis of the 2024 ESVS clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUAN Ding

Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YUAN Ding, Email: docyuanding@gmail.com

Keywords：

clinical practice guidelines; European Society for Vascular Surgery; peripheral arterial disease; lower extremity arterial disease; endovascular procedures; interpretation

DOI：

10.7507/1007-9424.202502114

Video：

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Peripheral artery disease (PAD) of the lower extremities, which pose a major challenge in the field of global public health, has seen a rising trend in its incidence and disability rate year by year. With the continuous innovation of new diagnostic techniques, imaging evaluation methods, and treatment strategies, profound changes have taken place in the diagnosis and treatment paradigm in this field. Based on the “European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication” issued by the European Society for Vascular Surgery in 2024, we systematically review the relevant international guidelines in recent years and conduct horizontal comparisons. Combining with the latest clinical research evidence, it conducts an in-depth analysis from the perspective of evidence-based medicine on the strategic evolution, technical key point updates, and clinical evidence levels of endovascular treatment for lower extremity PAD. The aim is to provide an evidence-based medical basis for clinical decision-making.

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1. Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2024, 67(2): 192-331.
2. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg, 2019, 69(6S): 3S-125S. e40. doi: 10.1016/j.jvs.2019.02.016.
3. 血管外科学会、欧洲血管外科学会和世界血管学会联盟全球血管指南编写小组. 慢性肢体威胁性缺血治疗的全球血管指南(全译). 中华血管外科杂志, 2021, 6(Z1): 1-108,F3.
4. Society for Vascular Surgery Lower Extremity Guidelines Writing Group; Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg, 2015, 61(3 Suppl): 2S-41S.
5. Aboyans V, Ricco JB, Bartelink MEL, et al. Editor’s choice—2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(3): 305-368.
6. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
7. Feldman DN, Armstrong EJ, Aronow HD, et al. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv, 2018, 92(1): 124-140.
8. Feldman DN, Armstrong EJ, Aronow HD, et al. SCAI guidelines on device selection in aorto-iliac arterial interventions. Catheter Cardiovasc Interv, 2020, 96(4): 915-929.
9. Koeckerling D, Raguindin PF, Kastrati L, et al. Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. Eur Heart J, 2023, 44(11): 935-950.
10. Klein WM, van der Graaf Y, Seegers J, et al. Dutch iliac stent trial: long-term results in patients randomized for primary or selective stent placement. Radiology, 2006, 238(2): 734-744.
11. Jongsma H, Bekken J, Ayez N, et al. Angioplasty versus stenting for iliac artery lesions. Cochrane Database Syst Rev, 2020, 12(12): CD007561. doi: 10.1002/14651858.CD007561.pub3.
12. Goode SD, Cleveland TJ, Gaines PA, et al. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg, 2013, 100(9): 1148-1153.
13. Bekken JA, Vroegindeweij D, Vos JA, et al. Editor’s choice—Two year results of the randomised DISCOVER trial comparing covered versus bare metal stents in the common iliac artery. Eur J Vasc Endovasc Surg, 2023, 65(3): 359-368.
14. Krankenberg H, Zeller T, Ingwersen M, et al. Self-expanding versus balloon-expandable stents for iliac artery occlusive disease: The randomized ICE Trial. JACC Cardiovasc Interv, 2017, 10(16): 1694-1704.
15. Mwipatayi BP, Sharma S, Daneshmand A, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg, 2016, 64(1): 83-94.
16. Bontinis V, Bontinis A, Giannopoulos A, et al. Editor’s choice—Covered stents versus bare metal stents in the treatment of aorto-iliac disease: A systematic review and individual participant data meta-analysis. Eur J Vasc Endovasc Surg, 2024, 68(3): 348-358.
17. Kirkwood ML, Armstrong EJ, Ansari MM, et al. FORWARD study of GORE VIABAHN balloon-expandable endoprostheses and bare metal stents in the United States, European Union, United Kingdom, Australia, and New Zealand when placed to treat complex iliac occlusive disease: Protocol for a randomized superiority trial. JMIR Res Protoc, 2023, 12: e51480. doi: 10.2196/51480.
18. Qi Y, Wang J, Zhao J, et al. Comparison of BARD®LIFESTREAM™ covered balloon-expandable stent versus GORE® VIABAHN™ covered self-expandable stent in treatment of aortoiliac obstructive disease: study protocol for a prospective randomized controlled trial (NEONATAL trial). Trials, 2022, 23(1): 392. doi: 10.1186/s13063-022-06332-7.
19. Salem M, Hosny MS, Francia F, et al. Management of extensive aorto-iliac disease: A systematic review and meta-analysis of 9 319 patients. Cardiovasc Intervent Radiol, 2021, 44(10): 1518-1535.
20. Premaratne S, Newman J, Hobbs S, et al. Meta-analysis of direct surgical versus endovascular revascularization for aortoiliac occlusive disease. J Vasc Surg, 2020, 72(2): 726-737.
21. Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5 358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther, 2013, 20(4): 443-455.
22. Starodubtsev V, Mitrofanov V, Ignatenko P, et al. Editor’s choice—Hybrid vs. open surgical reconstruction for iliofemoral occlusive disease: A prospective randomised trial. Eur J Vasc Endovasc Surg, 2022, 63(4): 557-565.
23. Capoccia L, Riambau V, da Rocha M. Is femorofemoral crossover bypass an option in claudication?. Ann Vasc Surg, 2010, 24(6): 828-832.
24. Eiberg JP, Røder O, Stahl-Madsen M, et al. Fluoropolymer-coated dacron versus PTFE grafts for femorofemoral crossover bypass: randomised trial. Eur J Vasc Endovasc Surg, 2006, 32(4): 431-438.
25. Ricco JB, Probst H,. Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease. J Vasc Surg, 2008, 47(1): 45-53.
26. Ballotta E, Gruppo M, Mazzalai F, et al. Infrapopliteal arterial reconstructions for limb salvage in patients aged > or =80 years according to preoperative ambulatory function and residential status. Surgery, 2010, 148(1): 119-128.
27. Kang JL, Patel VI, Conrad MF, et al. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg, 2008, 48(4): 872-877.
28. Changal KH, Syed MA, Dar T, et al. Systematic review and proportional meta-analysis of endarterectomy and endovascular therapy with routine or selective stenting for common femoral artery atherosclerotic disease. J Interv Cardiol, 2019, 2019: 1593401. doi: 10.1155/2019/1593401.
29. Boufi M, Ejargue M, Gaye M, et al. Systematic review and meta-analysis of endovascular versus open repair for common femoral artery atherosclerosis treatment. J Vasc Surg, 2021, 73(4): 1445-1455.
30. Kaneta G, Husain S, Musto L, et al. Editor’s choice—Eligibility of common femoral artery atherosclerotic disease for endovascular treatment—the CONFESS study. Eur J Vasc Endovasc Surg, 2022, 64(6): 684-691.
31. Gouëffic Y, Nasr B. Commentary to eligibility of common femoral artery atherosclerotic disease for endovascular treatment: The CONFESS study. Eur J Vasc Endovasc Surg, 2022, 64(6): 692. doi: 10.1016/j.ejvs.2022.09.003.
32. Baumann F, Ruch M, Willenberg T, et al. Endovascular treatment of common femoral artery obstructions. J Vasc Surg, 2011, 53(4): 1000-1006.
33. Bonvini RF, Rastan A, Sixt S, et al. Endovascular treatment of common femoral artery disease: medium-term outcomes of 360 consecutive procedures. J Am Coll Cardiol, 2011, 58(8): 792-798.
34. Ng JJ, Choong AMTL. More randomized controlled trials are needed to support the use of endovascular treatment in common femoral artery atherosclerotic lesions. J Vasc Surg, 2021, 74(1): 345-346.
35. Djerf H, Millinger J, Falkenberg M, et al. Absence of long-term benefit of revascularization in patients with intermittent claudication: Five-year results from the IRONIC randomized controlled trial. Circ Cardiovasc Interv, 2020, 13(1): e008450. doi: 10.1161/CIRCINTERVENTIONS.119.008450.
36. Gunnarsson T, Gottsäter A, Bergman S, et al. Eight-year outcome after invasive treatment of infrainguinal intermittent claudication: A population-based analysis from the Swedish vascular register (Swedvasc). SAGE Open Med, 2020, 8: 2050312120926782. doi: 10.1177/2050312120926782.
37. Howard R, Albright J, Fleckenstein R, et al. Identifying potentially avoidable femoral to popliteal expanded polytetrafluoroethylene bypass for claudication using cross-site blinded peer review. J Vasc Surg, 2023, 77(2): 490-496.
38. Haqqani MH, Kester LP, Lin B, et al. Outcomes of lower extremity revascularization in octogenarians and nonagenarians for intermittent claudication. J Vasc Surg, 2023, 78(6): 1479-1488.
39. Thanigaimani S, Phie J, Sharma C, et al. Network meta-analysis comparing the outcomes of treatments for intermittent claudication tested in randomized controlled trials. J Am Heart Assoc, 2021, 10(9): e019672. doi: 10.1161/JAHA.120.019672.
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