Vein Versus Prosthetic Graft for Femoropopliteal Bypass Above the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
| Autor: | Martin Sharrock, Stavros A. Antoniou, George A. Antoniou |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Prosthetic graft Time Factors Femoropopliteal bypass 030204 cardiovascular system & hematology Prosthesis Design Risk Assessment Amputation Surgical law.invention Blood Vessel Prosthesis Implantation Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law Humans Medicine Popliteal Artery Saphenous Vein 030212 general & internal medicine Vein Vascular Patency Randomized Controlled Trials as Topic business.industry Graft Occlusion Vascular Absolute risk reduction Odds ratio Limb Salvage Confidence interval Blood Vessel Prosthesis Surgery Femoral Artery Treatment Outcome medicine.anatomical_structure Lower Extremity Meta-analysis Cardiology and Cardiovascular Medicine business |
| Zdroj: | Angiology. 70:649-661 |
| ISSN: | 1940-1574 0003-3197 |
| DOI: | 10.1177/0003319719826460 |
| Popis: | Conflicting evidence exists surrounding which conduit material is preferable in above-knee femoropopliteal bypass surgery. We performed a systemic review of electronic information sources to identify randomized controlled trials (RCTs) comparing vein versus prosthetic grafts in above-knee femoropopliteal bypasses. Eight RCTs reporting 1271 grafts (608 saphenous vein and 663 prosthetic) in 1132 patients were included. At 5 years, the vein group had significantly higher primary patency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.17-2.55, P = 0.006), primary assisted patency (OR: 4.02, 95% CI: 2.84-5.70, P < 0.0001), and secondary patency (OR: 1.83, 95% CI: 1.20-2.80, P = 0.005) rates compared with the prosthetic group. The vein group required significantly fewer reinterventions (OR: 0.33, 95% CI: 0.18-0.60, P = 0.0003). There was no significant difference in 30-day mortality (risk difference: −0.01, 95% CI: −0.02 to 0.01, P = 0.34), 30-day morbidity (OR: 1.58, 95% CI: 0.61-4.06, P = 0.35), major amputation (OR: 0.71, 95% CI: 0.43-1.18, P = 0.19), or overall survival (OR: 0.95, 95% CI: 0.70-1.30, P = 0.76) when comparing vein versus prosthetic grafts. Our analysis supports the use of the saphenous vein in above-knee femoropopliteal bypass grafting owing to its superiority in primary, primary assisted, and secondary patency rates and less need for reintervention when compared with prosthetic grafts. |
| Databáze: | OpenAIRE |
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