Related Experiment Videos
Long-term outcome of infrainguinal bypass grafting in patients with serologically proven hypercoagulability
Michael A Curi1, Christopher L Skelly, Zachary K Baldwin
1Section of Vascular Surgery, Department of Surgery, University of Chicago, IL 60637, USA.
Insights
Patients with hypercoagulability have significantly worse outcomes following infrainguinal bypass grafting, including lower graft patency, limb salvage, and survival rates. This highlights the importance of screening for clotting disorders in these individuals.
Area of Science:
- Vascular Surgery
- Thrombophilia
- Outcomes Research
Background:
- Infrainguinal bypass grafting is a critical procedure for limb salvage in patients with peripheral artery disease.
- The impact of hypercoagulable states on the long-term success of these grafts is not fully understood.
- Hypercoagulability, or a tendency to clot, can affect vascular interventions.
Purpose of the Study:
- To evaluate the long-term outcomes of infrainguinal bypass grafting in patients with and without hypercoagulability.
- To test the hypothesis that hypercoagulability leads to inferior graft results.
Main Methods:
- Retrospective analysis of 582 infrainguinal bypass grafts in 456 patients (1994-2001).
- Comparison of outcomes between patients with serologically proven hypercoagulable states and those without.
- Multivariate analysis to identify independent predictors of graft failure.
Main Results:
- 57 patients (13%) had hypercoagulable states, including heparin-induced platelet aggregation and antiphospholipid antibodies.
- Patients with hypercoagulability were younger and more likely to have had prior revascularization.
- At 5 years, hypercoagulable patients showed significantly poorer primary patency (28% vs. 35%), limb salvage (55% vs. 67%), and survival (61% vs. 74%).
- Hypercoagulability was an independent predictor of graft failure.
Conclusions:
- Serologically proven hypercoagulability is associated with inferior long-term patency, limb salvage, and survival after infrainguinal bypass.
- The high prevalence of hypercoagulable states warrants consideration for routine serologic screening in relevant patient populations.
- These findings underscore the need for tailored management strategies for patients with hypercoagulability undergoing vascular surgery.
Objective:
The purpose of this study was to test the hypothesis that the long-term outcome of infrainguinal bypass grafting in patients with congenital or acquired hypercoagulability is inferior to the results in patients without documented clotting disorders.
Methods:
The study was a retrospective analysis of consecutive patients from January 1994 to January 2001.
Results:
Five hundred eighty-two infrainguinal bypass grafts were created in 456 patients. Indication for surgery was limb-threatening ischemia in 84%; prosthetic conduits were implanted in 38%. Seventy-four grafts were created in 57 patients with one or more serologically proven hypercoagulable states, including heparin-induced platelet aggregation (n = 37), anticardiolipin antibodies (n = 11), lupus anticoagulant (n = 8), protein C or S deficiency (n = 7), antithrombin III deficiency (n = 3), and factor V Leiden mutation (n = 1). Patients with hypercoagulability were younger (63 +/- 2 years versus 69 +/- 1 years; P =.007), more likely to have undergone prior revascularization attempts (38% versus 21%; P =.003), and more likely to have chronic anticoagulation therapy after surgery (46% versus 25%; P =.001). After 5 years (median follow-up, 19 months), patients with hypercoagulability had poorer primary patency (28% +/- 7% versus 35% +/- 5%; P =.004), primary assisted patency (37% +/- 7% versus 45% +/- 6%; P =.0001), secondary patency (41% +/- 7% versus 53% +/- 6%; P =.0001), limb salvage (55% +/- 8% versus 67% +/- 6%; P =.009), and survival (61% +/- 8% versus 74% +/- 4%; P =.02) rates. Multivariate analysis identified only prosthetic conduit choice (P =.0001), hypercoagulability (P =.0003), and limb salvage indication (P =.01) as independent predictors of graft failure.
Conclusion:
Patients with serologically proven hypercoagulability have inferior long-term patency, limb salvage, and survival rates after infrainguinal bypass. The high prevalence rate (13%) of diverse hypercoagulable states in this patient population supports serologic screening, especially in referral practices.