Meta-analysis of allograft bypass grafting to infrapopliteal arteries.
OBJECTIVE
To determine graft patency and limb preservation after allograft bypass grafting to infrapopliteal arteries for different allograft materials.


METHODS
Meta-analysis of case series that used survival analysis to describe outcomes.


METHODS
Studies published from 1982 through 2003 were identified from electronic databases and pertinent original articles. Four series of cryopreserved arterial allografts, 10 series of cryopreserved vein allografts, three series of cold-storaged vein allografts, and 16 series of umbilical-cord vein allografts were included in separate random-effects meta-analyses.


RESULTS
A graphical display of pooled survival curves of graft patency showed cold-storaged veins to have the best outcome in the first 4 years, followed by cryopreserved arteries, umbilical-cord veins, and cryopreserved veins. The respective 5-year pooled patency were 24, 21, 30, and 19%. For foot preservation, the best outcome was achieved with cryopreserved arteries followed by cryopreserved veins, umbilical-cord veins, and cold-storaged veins. A reference meta-analysis of polytetrafluoroethlylene grafts occupied the top position for graft patency and the second position for foot preservation.


CONCLUSIONS
In leg revascularisation for critical ischaemia, graft patency is poor for allografts generally, but using peripheral allografts in repeat attempts at revascularisation is a valid strategy to prevent major amputation. A role for umbilical-cord vein allografts remains uncertain.
Vascular Surgery Section, Department of Surgery, University of São Paulo Medical School, São Paulo, SP, Brazil. albersm@uol.com.br
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M
Albers
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M
Romiti
C A B
CA
Pereira
M
M
Antonini
M
M
Wulkan
D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006083:Graft Occlusion, Vascular; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D011150:Popliteal Artery / Q000601:surgery*; D014654:Vascular Patency