Intravascular brachytherapy for peripheral vascular disease

Hansrani M, Overbeck K, Smout JJ, Stansby GP

Published Online:

October 8, 2008

Intravascular brachytherapy (radiation treatment) inside arteries or bypass grafts after angioplasty or stent surgery, may prevent arteries narrowing again, but more research is needed. Narrowed and blocked arteries can be treated by bypassing the blockage using a graft, or angioplasty (widening the artery by inserting a balloon), or inserting a stent (thin metal sleeve) to hold the artery open. However, restenosis (return of the narrowing or blockage) often occurs within a year. Intravascular brachytherapy (IVBT) aims to prevent restenosis by the application of radiation to the affected part of the artery after angioplasty or stent insertion. The review found only one small trial, which showed that IVBT reduced restenosis. However, more research is needed, especially regarding the long-term effects and complications of this treatment.

Abstract (click to read)

Background:

International treatment of atherosclerotic narrowed and blocked arteries involves either bypassing the blockage using a graft, widening it from the inside with a balloon, a procedure known as percutaneous transluminal angioplasty (PTA), or providing a strut to hold the vessel open, known as a stent. All of these treatments are however limited by the high numbers that fail within a year. Intravascular brachytherapy (IVBT) is the application of radiation directly to the site of vessel narrowing. It is known to inhibit the processes that lead to restenosis (narrowing) of vessels and grafts after treatment.

Objectives:

The objective of this review was to assess the efficacy and complications of intravascular brachytherapy on maintaining patency after angioplasty or stent insertion in native vessels or bypass grafts of the iliac or infrainguinal arteries.

Search strategy:

The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched 5 July 2002), the Cochrane Controlled Trials Register (last searched Issue 2, 2002), MEDLINE, EMBASE and reference lists of relevant articles.

Selection criteria:

Randomised trials of the use of brachytherapy as an adjunct to the treatment of patients with peripheral arterial diseases (PAD) or stenosed bypass grafts of the iliac or infrainguinal arteries arteries versus the procedure without brachytherapy.

Data collection and analysis:

Two reviewers independently assessed trial quality and extracted data. Adverse events information was collected from the trials.

Main results:

One trial was identified which met the inclusion criteria, involving 117 patients, mean age 71 years (43-89). The trial compared PTA versus PTA and IVBT in patients with long-segment de novo or restenotic lesions or occlusions of any length in the femoropopliteal artery. Results were provided at six month follow up in 107 patients (54 PTA alone, 53 PTA+IVBT). The results favoured adjuvant IVBT in preventing restenosis/occlusion with an odds ratio (OR) of 0.35 (95% CI 0.24 to 0.53). Analysis of subgroups showed a significant benefit of IVBT in non-diabetics, OR 0.22 (95% CI 0.07 to 0.69), in those undergoing IVBT in restenotic lesions, OR 0.32 (95% CI 0.10 to 1.01), occlusive lesions, OR 0.19 (95% CI 0.06 to 0.62) and lesions in which the PTA length was greater than 10cm, OR 0.24 (95% CI 0.09 to 0.62).

Authors' conclusions:

Results from the only trial available would suggest that IVBT is effective at improving the patency of femoropopliteal arteries undergoing PTA in the short-term, particularly in non-diabetics with long occlusions (>10cm).

This record should be cited as:

Hansrani M, Overbeck K, Smout JJ, Stansby GP. Intravascular brachytherapy for peripheral vascular disease. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003504. DOI: 10.1002/14651858.CD003504

Assessed as up to date:

July 5, 2002

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Primary Review Group:

Peripheral Vascular Diseases Group

Health topics:

Heart & circulation > Peripheral vascular disease > Critical limb ischaemia

Heart & circulation > Peripheral vascular disease > Peripheral arterial occlusive disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Intravascular brachytherapy for peripheral vascular disease

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