An updated meta-analysis of infrainguinal arterial reconstruction in patients with end-stage renal disease.
BACKGROUND
A previous meta-analysis reported on the mid-term outcomes of infrainguinal bypass grafts in patients with critical limb ischemia and end-stage renal disease. Given the competing interest in endovascular procedures, the results of bypass surgery must be assessed as precisely as possible for future comparison. In this study, the original meta-analysis was refined and updated by increasing the number of studies reviewed, estimating primary graft patency, extending follow-up time, and investigating the problem of early amputation despite a patent graft.


METHODS
Studies published from 1987 through 2005 were identified from two electronic databases. Two investigators independently extracted the survival data from life tables, survival curves, and texts. Pooled survival curves were then constructed for graft patency, limb salvage, and patient survival according to a random-effects protocol for meta-analysis.


RESULTS
Of 28 articles included, 18 reported amputation despite a patent graft in 84 (10%) out of 844 limbs, and 25 described a perioperative mortality of 88 (8.8%) out of 996 patients. The 5-year pooled estimate (SE) was 50.4% (15.4%) for primary patency, 50.8% (19.0%) for secondary patency, 66.6% (11.2%) for limb salvage, and 23.0% (11.7%) for patient survival. No publication bias was detected.


CONCLUSIONS
Limb salvage can be achieved in most end-stage renal disease patients who undergo bypass surgery for critical ischemia, but survival is poor. To avoid early amputation despite a patent graft, bypass grafting should not be offered to patients with a great amount of tissue loss or extensive infection.
Albers
Maximiano
M
Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada Foundation (UNILUS), Santos, SP, Brazil. albersm@uol.com.br
Romiti
Marcello
M
De Luccia
Nelson
N
Brochado-Neto
Francisco Cardoso
FC
Nishimoto
Inês
I
Pereira
Carlos Alberto Bragança
CA
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001158:Arteries / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000706:statistics & numerical data*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data