Meta-analysis of outcomes from drug-eluting stent implantation in infrapopliteal arteries

BACKGROUND Percutaneous drug-eluting stent implantation(DESI)is an emerging and promising treatment modality for infrapopliteal artery diseases(IPADs).This systematic review and meta-analysis summarizes and quantitatively analyzes the outcomes of DESI in IPADs considering the hazard ratio(HR),which is a more accurate and appropriate outcome measure than the more commonly used relative risk and odds ratio.AIM To explore the superiority of drug-eluting stents(DESs)vs traditional treatment modalities for IPADs.METHODS The following postoperative indicators were the outcomes of interest:All-cause death(ACD)-free survival,major amputation(MA)-free survival,target lesion revascularization(TLR)-free survival,adverse event(AE)-free survival,and primary patency(PP)survival.The outcome measures were then compared according to their respective HRs with 95%confidence intervals(CIs).The participants were human IPAD patients who underwent treatments for infrapopliteal lesions.DESI was set as the intervention arm,and traditional percutaneous transluminal angioplasty(PTA)with or without bare metal stent implantation(BMSI)was set as the control arm.A systematic search in the Excerpta Medica Database(Embase),PubMed,Web of Science,and Cochrane Library was performed on November 29,2022.All controlled studies published in English with sufficient data on outcomes of interest for extraction or conversion were included.When studies did not directly report the HRs but gave a corresponding survival curve,we utilized Engauge Digitizer software and standard formulas to convert the information and derive HRs.Then,meta-analyses were conducted using a random-effects model.RESULTS Five randomized controlled trials and three cohort studies involving 2639 participants were included.The ACDfree and MA-free survival HR values for DESI were not statistically significant from those of the control treatment(P>0.05);however,the HR values for TLR-free,AE-free,and PP-survival differed significantly[2.65(95%CI:1.56-4.50),1.57(95%CI:1.23-2.01),and 5.67(95%CI:3.56-9.03),respectively].CONCLUSION Compared with traditional treatment modalities(i.e.,PTA with or without BMSI),DESI for IPADs is superior in avoiding TLR and AEs and maintaining PP but shows no superiority or inferiority in avoiding ACD and MA.

Dynamic Lower-Limb Alignment Focusing on Gait Stability

Introduction: Prosthetic limbs must be developed with proper alignment to facilitate safe and efficient gait patterns. This study aimed to identify factors impacting clinically proper gait patterns by objectively evaluating them in persons with lower-limb amputations who use prosthetic limbs. Materials and Methods: This non-experimental descriptive study assessed 58 persons with amputation who used prosthetic limbs. The mechanical axis angle (MAA) of the lower limb during the heel contact, midstance, and toe-off phases and the angle between the tube and floor during the midstance phase were measured using coronal plane gait images. We also investigated whether the MAA and tube angle during the midstance phase have a multimodal distribution. In case of multimodal distributions, we tested for significant between-group differences in patient characteristics. Results: The MAA and tube angle in the coronal plane during the midstance phase had a bimodal distribution (mean 0°). There was a significant difference in the duration of prosthetic limb use between the MAA < 0° and ≥0° groups during the midstance phase. Deviations in the lower limb MAA between the heel contact and midstance phases were 3.3° ± 2.2° and 3.1° ± 2.3° for persons with lower limb amputations in the MAA Conclusions: In this study, prosthetic alignment during the midstance phase had a bimodal distribution. In both groups, deviations in the lower limb MAA were aligned to be approximately 3°.