LAUSR

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.