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• W2049063779 abstract "According to a recent meta-analysis of uncontrolled series by Pereira et al (J Vasc Surg 2006;44:510-7), saphenous vein grafts performed better than polytetrafluoroethylene (PTFE) grafts in above-knee femoropopliteal bypass. The best evidence that a treatment surpasses another, however, should come from a meta-analysis of randomized controlled trials (RCTs). When only RCTs in a systematic review of above-knee femoropopliteal bypass by Klinkert et al1Klinkert P. Post P.N. Breslau P.J. van Bockel J.H. Saphenous vein versus PTFE for above-knee femoropopliteal bypass A review of the literature.Eur J Vasc Endovasc Surg. 2004; 27: 357-362Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar (published in 2004) were considered, the patency of saphenous vein grafts was better than that for PTFE grafts. The analysis included four RCTs by Veith et al,2Veith F.J. Gupta S.K. Ascer E. White-Flores S. Samson R.H. Scher L.A. et al.Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions.J Vasc Surg. 1986; 3: 104-114PubMed Scopus (944) Google Scholar AbuRahma et al,3AbuRahma A.F. Robinson P.A. Holt S.M. Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses.Surgery. 1999; 126: 594-602Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar Johnson and Lee,4Johnson W.C. Lee K.K. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study.J Vasc Surg. 2000; 32: 268-277Abstract Full Text Full Text PDF PubMed Scopus (234) Google Scholar and Burger et al.5Burger D.H. Kappetein A.P. van Bockel J.H. Breslau P.J. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting.J Vasc Surg. 2000; 32: 278-283Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar After the inclusion period (from 1966 to 2002) of the review by Klinkert et al,1Klinkert P. Post P.N. Breslau P.J. van Bockel J.H. Saphenous vein versus PTFE for above-knee femoropopliteal bypass A review of the literature.Eur J Vasc Endovasc Surg. 2004; 27: 357-362Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar to our knowledge, Klinkert et al6Klinkert P. Schepers A. Burger D.H. van Bockel J.H. Breslau P.J. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial.J Vasc Surg. 2003; 37: 149-155Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar updated the 2-year outcomes of the RCT by Burger et al,5Burger D.H. Kappetein A.P. van Bockel J.H. Breslau P.J. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting.J Vasc Surg. 2000; 32: 278-283Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar and Ballotta et al7Ballotta E. Renon L. Toffano M. Da Giau G. Prospective randomized study on bilateral above-knee femoropopliteal revascularization: polytetrafluoroethylene graft versus reversed saphenous vein.J Vasc Surg. 2003; 38: 1051-1055Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar reported the results of another RCT. Although a bypass with saphenous vein grafts had better patency in the RCT by Klinkert et al,6Klinkert P. Schepers A. Burger D.H. van Bockel J.H. Breslau P.J. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial.J Vasc Surg. 2003; 37: 149-155Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar saphenous vein and PTFE grafts had a statistically comparable patency in the RCT by Ballotta et al.7Ballotta E. Renon L. Toffano M. Da Giau G. Prospective randomized study on bilateral above-knee femoropopliteal revascularization: polytetrafluoroethylene graft versus reversed saphenous vein.J Vasc Surg. 2003; 38: 1051-1055Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar To test the hypothesis that saphenous vein and PTFE grafts are equally beneficial in above-knee femoropopliteal bypass, we performed a meta-analysis of currently available RCTs of saphenous vein vs PTFE grafts in above-knee femoropopliteal bypass. Our comprehensive search identified 5 RCTs2Veith F.J. Gupta S.K. Ascer E. White-Flores S. Samson R.H. Scher L.A. et al.Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions.J Vasc Surg. 1986; 3: 104-114PubMed Scopus (944) Google Scholar, 3AbuRahma A.F. Robinson P.A. Holt S.M. Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses.Surgery. 1999; 126: 594-602Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 4Johnson W.C. Lee K.K. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study.J Vasc Surg. 2000; 32: 268-277Abstract Full Text Full Text PDF PubMed Scopus (234) Google Scholar, 5Burger D.H. Kappetein A.P. van Bockel J.H. Breslau P.J. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting.J Vasc Surg. 2000; 32: 278-283Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar, 6Klinkert P. Schepers A. Burger D.H. van Bockel J.H. Breslau P.J. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial.J Vasc Surg. 2003; 37: 149-155Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar that included 395 saphenous vein and 435 PTFE grafts. We analyzed the primary patency of three RCTs2Veith F.J. Gupta S.K. Ascer E. White-Flores S. Samson R.H. Scher L.A. et al.Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions.J Vasc Surg. 1986; 3: 104-114PubMed Scopus (944) Google Scholar, 3AbuRahma A.F. Robinson P.A. Holt S.M. Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses.Surgery. 1999; 126: 594-602Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 5Burger D.H. Kappetein A.P. van Bockel J.H. Breslau P.J. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting.J Vasc Surg. 2000; 32: 278-283Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar and the primary assisted patency of two RCTs4Johnson W.C. Lee K.K. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study.J Vasc Surg. 2000; 32: 268-277Abstract Full Text Full Text PDF PubMed Scopus (234) Google Scholar, 6Klinkert P. Schepers A. Burger D.H. van Bockel J.H. Breslau P.J. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial.J Vasc Surg. 2003; 37: 149-155Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar because these two RCTs did not report primary patency. The pooled primary graft patency of saphenous vein and PTFE grafts was 86.6% and 83.7% at 1 year, 82.6% and 74.6% at 2 years, 79.2% and 65.3% at 3 years, 77.6% and 61.3% at 4 years, and 76.4% and 56.1% at 5 years, respectively (Fig). Risk ratios (<1, favors PTFE grafts; >1, favors saphenous vein grafts) for graft occlusion pooled by using a random-effects model were 1.13 (confidence interval, 0.85-1.52; P = .3957) at 1 year, 1.34 (confidence interval, 1.05-1.70; P = .0198) at 2 years, 1.44 (confidence interval, 1.16-1.80; P = .0011) at 3 years, 1.52 (confidence interval, 1.23-1.87; P < .0001) at 4 years, and 1.68 (confidence interval, 1.34-2.11; P < .0001) at 5 years. There was neither between-study heterogeneity nor publication bias. The best evidence on the basis of the present meta-analysis of RCTs demonstrated that saphenous vein grafts were superior to PTFE grafts in above-knee femoropopliteal bypass, thus supporting the conclusions of the meta-analysis of uncontrolled series by Pereira et al. ReplyJournal of Vascular SurgeryVol. 46Issue 3PreviewWe agree with Dr Takagi that a meta-analysis of randomized controlled trials provides the best scientific evidence. However, they are scarce in the literature. Full-Text PDF Open Archive" @default.
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• W2049063779 title "Regarding “Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency”" @default.
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