Revascularization for lower limb peripheral arterial disease
Authors: Vlayen Joan , Holdt Henningsen Kirsten , d'Archambeau Olivier , Fourneau Inge , Heyndrickx Benedicte , Kolh Philippe , Maleux Geert , Motte Serge , Sprynger Muriel , Vermassen Frank , Sharpin Carlos , Neilson Julie , Westby Maggie , Carville Serena , Jones Katie 
Published: January 2025

COMPOSITION OF THE GUIDEL INE DEVELOPMENT GROUP 17 -- 1.1. COMPOSITION OF THE GUIDEL INE DEVELOPMENT GROUP 17 -- 1.2. COMPOSITION OF THE KCE EXPERT TEAM 17 -- 1.3. RESEARCHERS INVOLVED IN THE GUIDELINE 18 -- 2. SEARCH STRATEGIES 19 -- 2.1. SEARCH STRATEGY FOR GUIDELINES 19 -- 2.2. SEARCH STRATEGIES FOR OTHER PUBLICATIONS (SYSTEMATIC REVIEWS, META-ANALYSES, INDIVIDUAL STUDIES) 20 -- 2.2.1. Assessment of PAD 20 -- 2.2.2. Selective versus primary stenting 27 -- 2.2.3. Bare metal versus drug eluting stents 35 -- 2.2.4. Autologous vein versus prosthetic bypass 42 -- 2.2.5. Drug-coated balloon angioplasty 49 -- 2.3. SEARCH FOR PATIENT ISSUES 57 -- 3. QUALITY APPRAISAL 65 -- 3.1. QUALITY APPRAISAL TOOLS 65 -- 3.1.1. Guidelines 65 -- 3.1.2. Systematic reviews 67 -- 3.1.3. Primary studies for diagnosis 69 -- 3.1.4. Primary studies for treatment 72 -- 3.2. GUIDELINE QUALITY APPRAISAL RESULTS 74 -- 3.3. STUDY SELECTION AND QUALITY APPRAISAL 75 -- 3.3.1. Assessment of PAD 75 -- 3.3.2. Selective versus primary stenting 87 -- 3.3.3. Bare metal versus drug elutingstents 99 -- 3.3.4. Autologous vein versus prosthetic bypass 110 -- 3.3.5. Drug-coated balloon angioplasty 120 -- 4.EVIDENCE TABLES BY CLINICAL QUESTION 135 -- 4.1.ASSESSMENT OF PAD 135 -- 4.1.1.Diagnostic test accuracy studies 135 -- 4.1.2.Test and treat studies 173 -- 4.2.SELECTIVE VERSUS PRIMARY STENTING 178 -- 4.2.1.New evidence published since NICE guideline 178 -- 4.2.2.Evidence tables for angioplasty with selective stents vs angioplasty with primary stents from NICE guideline CG147 187 -- 4.3.BARE METAL VERSUS DRUG ELUTING STENTS 230 -- 4.4.AUTOLOGOUS VEIN VERSUS PROSTHETIC BYPASS 249 -- 4.4.1.New evidence published since NICE guideline 249 -- 4.4.2.Evidence tables for autologous vein compared to prosthetic bypass from NICE guideline CG147 254 -- 4.5.DRUG-COATED BALLOON ANGIOPLASTY 261 -- 5.GRADE TABLES 273 -- 5.1.ASSESSMENT OF PAD 273 -- 5.1.1.Whole leg, 50-100% stenosis 273 -- 5.1.2.Whole leg, 70-100% stenosis 274 -- 5.1.3.Whole leg, 100% stenosis 275 -- 5.1.4.Above the knee, 50-100% stenosis 276 -- 5.1.5.Above the knee, 70-100% stenosis 277 -- 5.1.6.Above the knee, 100%stenosis 278 -- 5.1.7.Below the knee, 50-100% stenosis 279 -- 5.1.8.Below the knee, 70-100% stenosis 280 -- 5.1.9.Below the knee, 100%stenosis 281 -- 5.1.10.Imaging of the foot 282 -- 5.1.11.Test and treat, CE MRA versus CTA 283 -- 5.1.12.Test and treat, CE MRA versus DUS 284 -- 5.2.REVASCULARIZATION COMPAREDWITH OR IN COMBINATION WITH EXERCISE OR BEST -- 5.2.1.Best medical treatment versus best medical treatment with angioplasty 285 -- 5.2.2.Supervised exercise with best medical treatment and angioplasty versus supervised exercise with best medical treatment 289 -- 5.2.3.Best medical treatment with supervised exercise and angioplasty versus best medical treatment and angioplasty 292 -- 5.2.4.Angioplasty versus supervised exercise 294 -- 5.2.5.Bypass surgery versus supervised exercise 298 -- 5.3.ANGIOPLASTY VERSUS BYPASS SURGERY FOR INTERMITTENT CLAUDICATION 299 -- 5.3.1.Aortoiliac disease 299 -- 5.3.2.Femoropopliteal disease 301 -- 5.4.ANGIOPLASTY WITH SELECTIVE VERSUS PRIMARY STENT PLACEMENT FOR INTERMITTENT CLAUDICATION 303 -- 5.4.1.Aortoiliac disease 303 -- 5.4.2.Femoropopliteal disease 308 -- 5.4.3.Infrapopliteal disease 316 -- 5.5.BARE METAL VERSUS DRUG ELUTING STENTS FOR INTERMITTENT CLAUDICATION 317 -- 5.5.1.Femoropopliteal disease (mixed intermittent claudication and critical limb ischemia) 317 -- 5.5.2.Infrageniculatedisease .321 -- 5.6.AUTOLOGOUS VEIN VERSUS PROSTETHIC GRAFT FOR INTERMITTENT CLAUDICATION 323 -- 5.6.1.Femoropopliteal disease 323 -- 5.7.ANGIOPLASTY VERSUS BYPASS SURGERY FOR CRITICAL LIMBISCHEMIA 325 -- 5.7.1.Aortoiliac disease 325 -- 5.7.2.Femoropopliteal disease 326 -- 5.8.ANGIOPLASTY WITH SELECTIVE VERSUS PRIMARY STENT PLACEMENT FOR CRITICAL LIMB ISCHEMIA 329 -- 5.8.1.Infrapopliteal disease 329 -- 5.9.BARE METAL VERSUS DRUG ELUTING STENTSFOR CRITICAL LIMB ISCHEMIA 332 -- 5.9.1.Infrageniculate disease .332 -- 5.10.DRUG-COATED BALLOONS FOR CRITICAL LIMB ISCHEMIA 33 -- 5.10.1.Intermittent claudication or critical limb ischemia due to femoropopliteal lesions 334 -- 5.10.2.Intermittent claudication or critical limb ischemia due to femoropopliteal lesions: drug in contrast medium 336 -- 5.10.3.Intermittent claudication or critical limb ischemia due to femoropopliteal and/or infrapopliteallesions 338 -- 5.10.4.Critical limb ischemia due to infrapopliteal lesions, adultswith diabetes 340 -- 5.11.AUTOLOGOUS VEIN VERSUS PROSTETHIC GRAFT FOR CRITICAL LIMB ISCHEMIA 341 -- 6.FOREST PLOTS 342 -- 6.1.ASSESSMENT OF PAD 342 -- 6.1.1.DUS versus CTA versus CE MRA versus 2D TOF MRA versus 3D CE MRA: all compared with the reference standard, DSA 342 -- 6.1.2.DUS versus CTA versus CE MRA versus 2D TOF MRA: all compared with the reference standard, DSA  studies with more than one index test 363 -- 6.1.3.Diagnostic meta-analysis using bivariate hierarchical modelling 365 -- 6.1.4.Test and treat forest plots: MRA plus treatment versus CTA plus treatment -- . 379 -- 6.1.5.Test and treat forest plots: MRA plus treatment versus DUS plus treatment 381 -- 6.2.SELECTIVE VERSUS PRIMARY STENTING 383 -- 6.2.1.Intermittent claudication - aortoiliac lesions 383 -- 6.2.2.Intermittent claudication - femoropopliteal lesions 388 -- 6.2.3.Intermittent claudication - infrapopliteal lesions (person randomized) 396 -- 6.2.4.Critical limb ischemia - infrapopliteal lesions (person randomized) 397 -- 6.3.BARE METAL VERSUS DRUG ELUTING STENTS 400 -- 6.3.1.Intermittent claudication, femoro-popliteal lesions 400 -- 6.3.2.Intermittent claudication, infra-geniculate lesions 407 -- 6.3.3.Criticial Limb Ischemia, infra-geniculate lesions 409 -- 6.4.AUTOLOGOUS VEIN VERSUS PROSTHETIC BYPASS 412 -- 6.5.DRUG-COATED BALLOONANGIOPLASTY 416 -- 6.5.1.Drug coated balloons vs uncoated balloons  IC and CLI, femoro-popliteal lesions 416 -- 6.5.2.Drug coated balloons vs uncoated balloons with drug contrast medium  IC and CLI, femoro-popliteal lesions 419 -- 6.5.3.Drug coated balloons vs uncoated balloons IC and CLI, femoro-popliteal and infraopliteal lesions 421 -- 6.5.4.Drug coated balloons vs uncoated balloons  diabetic patients with CLI, infra-popliteal lesions 422 -- 7.METHODS FOR META-ANALYSIS 424 -- 7.1.DIAGNOSTIC META-ANALYSIS 424 -- 8.CONSULTATION OF STAKEHOLDERS 427 -- 9.NOMENCLATURECODES 429 -- 9.1.OVERVIEW 429 -- 9.2.EVOLUTION OF USE OF NOMENCLATURE CODES 432 -- 10.RIZIV-INAMI EXPENDITURE ANALYSIS 433 -- 10.1.CASE SELECTION 433 -- 10.2.METHOD 436 -- 10.3.EXPENDITURE CALCULATION .436 -- 10.4.HOSPITAL STAY SELECTION 436 -- 10.5.RESULTS 436 -- 10.5.1.Inpatient and day care 436 -- 10.5.2.Length of stay and per diempart expenditure 437 -- 10.5.3.Expenditure by intervention type and hospital stay type 438 -- 10.5.4.Expenditure by intervention type, hospital stay type, and qualification 439 -- 11. REFERENCES 441 --