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Can screening for genetic markers improve peripheral artery bypass patency?
Melina R Kibbe1, Andrea L Cortese Hassett, Frances McSherry
1Division of Vascular Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Journal of Vascular Surgery
|December 7, 2002
Summary
Genetic mutations like factor V Leiden and prothrombin do not increase thromboembolic risk after peripheral bypass. However, methylenetetrahydrofolate reductase (MTHFR) heterozygosity improves graft patency, while homozygosity is linked to thrombosis.
Area of Science:
- Vascular Surgery
- Genetics
- Thrombosis
Background:
- Factor V Leiden, prothrombin, and MTHFR mutations are linked to thromboembolic events.
- The impact of these genetic mutations on peripheral bypass outcomes is not fully understood.
Purpose of the Study:
- To investigate the effect of factor V Leiden, prothrombin, and MTHFR mutations on peripheral bypass patency.
- To assess the association between these mutations and preoperative/postoperative thromboembolic events.
Main Methods:
- 244 volunteers from Veterans Affairs Cooperative Study #362 were genotyped for MTHFR, factor V Leiden, and prothrombin mutations.
- Patients received aspirin or aspirin/warfarin post-bypass.
- Thromboembolic events and graft patency (PP, APP, SP) were compared among mutation carriers and wild-type subjects.
Main Results:
- MTHFR homozygous patients showed increased graft thrombosis (33.3%) and lower patency rates compared to heterozygotes.
- MTHFR heterozygous patients exhibited fewer graft thromboses (11.1%), fewer amputations, and superior patency rates versus wild-type controls.
- Factor V Leiden and prothrombin mutations did not correlate with increased risk of graft occlusion or thromboembolic events.
Conclusions:
- Factor V Leiden and prothrombin mutations do not appear to increase risk for peripheral bypass complications.
- MTHFR heterozygosity is associated with improved graft patency and reduced thrombosis after bypass.
- Preoperative MTHFR screening may identify patients at higher risk for graft thrombosis, guiding surgical management.