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OBJECTIVES: Surgical revascularisation for lower limb ischaemia remains an important component for optimisation of quality of life and symptomatology in patients with peripheral arterial disease. The objective of this meta-analysis is to establish which prosthetic graft, Dacron or PTFE, has the better long-term patency in patients undergoing an above-knee femoro-popliteal arterial bypass.
METHODS: This meta-analysis was performed using Cochrane and PRISMA guidelines. An electronic search of all relevant databases was performed from 1990 to 2013 using the Medical Subject Headings: ‘Dacron’,‘PTFE’,‘above knee’,‘femoropopliteal’,‘bypass’. The inclusion criteria were randomised controlled trials, use of Dacron vs. PTFE prosthetic conduits and completion of an above-knee femoro-popliteal arterial bypass involving adult patients aged over eighteen years presenting with disabling claudication, rest pain or tissue loss, occlusion of the superficial femoral artery and reconstitution of the above-knee popliteal artery. Graft patency rates were calculated using RevMan 5.1 software. When multiple studies were evaluated while original patency rates were documented when only one study result was available.
RESULTS: Ninety-one publications were reviewed. After exclusion of duplicate, non-randomised and alternative bypass surgery studies, four randomized controlled trials were identified involving 957 patients comprising 476 Dacron and 481 PTFE above-knee lower limb arterial bypasses. Mean age reported was 66 years and all patients had generalised cardiovascular co-morbidities and risk factors. Two studies evaluated 6mm grafts, one assessed 8mm grafts while the other study included graft sizes between 5mm and 8mm. Although primary and secondary patency rates at 12-months were not significantly different (RR 0.47, p=0.52 & RR 0.84, p=0.52), 24- and 60-month primary patency rates were better with Dacron compared to PTFE grafts (RR 0.81, p=0.03 and 52% vs. 36%, p=0.04). Statistical analysis also supported higher secondary patency rate for Dacron at 24- (RR 0.75,p=0.02) and 60-months (70% vs. 51%,p=0.01). Ten-year patency rates were similar. Antiplatelet / anticoagulation therapy was prescribed in 85% of patients in one trial. However, exact best medical therapy strategies were not described in the other studies. There was no difference in amputation, overall morbidity or mortality rates between the two surgical graft populations.
CONCLUSIONS: Current evidence suggests that Dacron prosthetic grafts are superior to PTFE grafts in above-knee femoro-popliteal arterial bypass procedures. Further randomised trials targeting standardisation of confounding variables particularly graft size and best medical therapy are warranted.