title: Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency.
abstract: BACKGROUND
  In femoropopliteal bypass surgery, the use of saphenous vein grafts is preferable, but synthetic grafts are widely used above the knee. The objective of this meta-analysis was to assess the long-term patency of femoropopliteal bypass grafts classified as above-knee polytetrafluoroethylene, above-knee saphenous vein, or below-knee saphenous vein.
  
  
  METHODS
  Studies published from 1986 through 2004 were identified from electronic databases and reference lists; 73 articles contributed 1 or more series that used survival analysis, assessed femoropopliteal bypasses in one of the foregoing configurations, reported a 1-year graft patency rate, and included at least 30 bypasses. The series with a predominance of claudicant patients were included in meta-analysis C, and the series in which critical ischemia predominated were included in meta-analysis CI. Pooled survival curves of graft patency were constructed.
  
  
  RESULTS
  In meta-analysis C, the pooled primary graft patency was 57.4% for above-knee polytetrafluoroethylene, 77.2% for above-knee vein, and 64.8% for below-knee vein at 5 years; there was a significant difference between above-knee grafts at 3, 4, and 5 years (P < .05). The corresponding pooled secondary graft patency was 73.2%, 80.1%, and 79.7%, respectively (P > .05). In meta-analysis CI, the pooled primary graft patency was 48.3% for above-knee polytetrafluoroethylene, 69.4% for above-knee vein, and 68.9% for below-knee vein at 5 years; there was a significant difference between above-knee grafts until 4 years (P < .05). The corresponding pooled secondary graft patency was 54.0%, 71.9%, and 77.8%, respectively, with a significant difference between above-knee grafts at 2, 3, and 4 years (P < .05).
  
  
  CONCLUSIONS
  The great saphenous vein performs better than polytetrafluoroethylene in femoropopliteal bypass grafting and should be used whenever possible.
authors.affiliation: Department of Surgery, Vascular Surgery Section, Health and Medical Sciences Sector, Lusiada Foundation-UNILUS, Santos, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Pereira
authors.forename: Maximiano
authors.initials: M
authors.lastname: Albers
authors.forename: Marcello
authors.initials: M
authors.lastname: Romiti
authors.forename: Francisco Cardoso
authors.initials: FC
authors.lastname: Brochado-Neto
authors.forename: Carlos Alberto Braganaa
authors.initials: CA
authors.lastname: Pereira
mesh_terms: D001157:Arterial Occlusive Diseases / Q000601:surgery*; D006801:Humans; D011138:Polytetrafluoroethylene; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
chemical_list: D011138:Polytetrafluoroethylene