title: Systematic review and meta-analysis of vein cuffs for below-knee synthetic bypass.
abstract: BACKGROUND
  The aim was to investigate the possible benefit of vein cuffs for femoral to below-knee popliteal and femorodistal vessel synthetic bypass grafts.
  
  
  METHODS
  PubMed, the Cochrane library, Embase and ClinicalTrials.gov were searched for all studies on any clinical effect of vein cuffs on synthetic grafts. Outcomes were selected based on inclusion in two or more studies: primary patency and limb survival. The data were subjected to meta-analysis by outcome.
  
  
  RESULTS
  Three cohort and two randomized studies were selected for inclusion, involving 885 patients. Meta-analysis of five studies examining below-knee popliteal bypass showed a significant improvement for primary patency in cuffed grafts at 2 years, but not at 1 or 3 years (odds ratio at 2 years 0·46, 95 per cent confidence interval 0·22 to 0·97; P = 0·04). Limb salvage was significantly improved in cuffed grafts up to 2 years. Limb survival was also improved for cuffed distal grafts at 2 years (odds ratio 0·29, 0·11 to 0·75; P = 0·01) but showed no difference at any other time interval. Study quality was generally poor, with conflicting results.
  
  
  CONCLUSIONS
  There was a small but significant benefit for vein cuffs on synthetic grafts used for femoral to below-knee popliteal anastomoses, but little benefit for femorodistal anastomoses.
authors.affiliation: Department of Vascular and Endovascular Surgery, Morriston Hospital, Swansea, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Twine
authors.forename: I M
authors.initials: IM
authors.lastname: Williams
authors.forename: L J
authors.initials: LJ
authors.lastname: Fligelstone
mesh_terms: D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply*; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011152:Popliteal Vein / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene