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


METHODS
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.


RESULTS
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.


CONCLUSIONS
The popliteal-to-distal vein bypass is a tool of high efficiency in the treatment of severe, chronic critical ischemia in the lower extremity.
Albers
Maximiano
M
Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada Foundation, Santos, Sao Paulo, Brazil.
Romiti
Marcello
M
Brochado-Neto
Francisco Cardoso
FC
De Luccia
Nelson
N
Pereira
Carlos Alberto Bragança
CA
D048909:Diabetes Complications / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D011150:Popliteal Artery / Q000601:surgery*; D014654:Vascular Patency