Meta-analysis of popliteal-to-distal vein bypass grafts for critical ischemia

• Published in: Journal of vascular surgery 2006-03, Vol.43 (3), p.498-503.e2
• Main Authors: Albers, Maximiano, Romiti, Marcello, Brochado-Neto, Francisco Cardoso, De Luccia, Nelson, Pereira, Carlos Alberto Bragança
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diabetes Complications - surgery; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive care: renal failure. Dialysis management; Humans; Intensive care medicine; Ischemia - surgery; Leg - blood supply; Medical sciences; Popliteal Artery - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2005.11.025

Several studies have described the use of popliteal-to-distal bypass grafts, mostly in patients with diabetes mellitus who show tissue loss and represent a high-risk population. The study objective was to conduct meta-analysis to assess the long-term primary and secondary patency and foot preservation after popliteal-to-distal bypass grafts. Data was retrieved from studies published from 1981 through 2004 that were identified from an electronic database. Thirty-one series that used survival analysis reported a 1-year graft patency rate and included at least 15 bypasses. Data from life tables, survival curves, and texts were used to calculate an interval success rate for each month in each series of grafts. Monthly success rates were combined across series to obtain a pooled estimate of success for each month, according to a random-effects protocol for meta-analysis. Pooled survival curves were then constructed for graft patency and foot preservation. The 5-year pooled estimate ± standard error was 63.1% ± 4.3% for primary patency, 70.7% ± 4.6% for secondary patency, and 77.7% ± 4.3% for foot preservation. There was a superiority trend favoring reversed vein grafts and tibial bypasses that became more apparent in sensitivity analysis. No publication bias was detected. The popliteal-to-distal vein bypass is a tool of high efficiency in the treatment of severe, chronic critical ischemia in the lower extremity.