Bypass Surgery With Heparin-Bonded Grafts for Chronic Lower Limb Ischemia.

Background: Our objective was to assess the effects of heparin-bonded grafts in infrainguinal bypass surgery for patients with peripheral arterial disease of the lower limbs.

Methods: We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting comparative outcomes of heparin-bonded grafts in patients undergoing infrainguinal bypass. We used the Cochrane collaboration tool for risk of bias assessment of randomized controlled trials (RCTs) and the Newcastle-Ottawa scale to assess the methodological quality of observational studies. Dichotomous outcome measures were calculated using odds ratio (OR) and 95% confidence interval (CI). Summary estimates of ORs were determined using the fixed-effect or random-effects model. The study protocol was registered in PROSPERO (CRD42016039185).

Results: We included 11 articles (3 RCTs) in qualitative and quantitative synthesis reporting a total of 2892 bypasses. Seven studies compared heparin-bonded grafts with vein grafts and another four compared heparin-bonded grafts with standard prosthetic grafts. We noted heterogeneity in disease severity and distal anastomotic level. We found a significantly lower perioperative mortality (OR, 2.30; 95% CI: 1.11-4.77), a trend toward better limb salvage at 1 year (OR, 0.50; 95% CI: 0.25-0.99), and a significantly higher limb salvage rate at 3 years (OR, 0.40; 95% CI: 0.23-0.69) in patients undergoing a vein bypass compared to those treated with heparin-bonded grafts. No differences were identified in graft patency or survival between the heparin-bonded and vein bypass graft group. No differences in primary patency were identified between heparin-bonded grafts and standard prosthetic grafts.

Conclusions: Heparin-bonded grafts showed comparable results to autologous vein in terms of graft patency and survival but lower limb salvage rates.