The efficacy of aspirin in patients undergoing infra-inguinal bypass and identification of high risk patients
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Published on: May 11, 2011
A Mahmood1, M Sintler, A T Edwards
1Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK.
Insights
Aspirin did not significantly improve graft patency or survival in infrainguinal bypass surgery for critical limb ischemia. Alternative antiplatelet strategies may be needed, especially for high-risk patients.
Area of Science:
- Vascular Surgery
- Pharmacology
- Clinical Audit
Background:
- Infrainguinal bypass is crucial for critical lower limb ischemia.
- Graft occlusion is a significant complication within the first year post-surgery.
- Evaluating adjuvant therapies like aspirin is vital for improving outcomes.
Purpose of the Study:
- To assess the efficacy of aspirin in maintaining infrainguinal bypass graft patency.
- To determine if aspirin improves patient survival after infrainguinal bypass surgery.
- To identify risk factors associated with graft failure and vascular death.
Main Methods:
- A retrospective audit of 125 infrainguinal bypass procedures performed in 1997.
- Comparison of outcomes between patients receiving aspirin and those not treated.
- Analysis of graft patency, limb salvage, and patient survival rates.
Main Results:
- Overall 2-year secondary graft patency was 71%, and limb salvage was 83%.
- Aspirin use showed a non-significant trend towards improved secondary patency (73% vs. 64%).
- Smoking and crural/pedal bypass were identified as independent risk factors for graft failure and vascular death.
Conclusions:
- Aspirin monotherapy was not a significant factor in preventing graft failure or vascular death.
- Consideration of dual antiplatelet therapy is warranted for high-risk patients.
- Further research into alternative antiplatelet regimens is recommended for specific patient groups.
Aim:
Infrainguinal bypass is an effective treatment for critical lower limb ischemia but up to 1/3 of these grafts will occlude within the 1st year. The aim of this audit was to evaluate the efficacy of aspirin in maintaining graft patency and also improving patient survival.
Methods:
In a single audited year (1997) 125 bypasses were carried out. Seventy-nine were on aspirin, 34 on no treatment and 12 were on other agents and hence excluded from analysis. The indication for surgery was critical ischaemia in 101 and disabling claudication in 12. Autologous vein was used in 104 and prosthetic grafts in 9.
Results:
The overall 2-year primary graft patency, secondary graft patency and limb salvage were 50%, 71% and 83%, respectively. The 2-year secondary patency in patients with or without aspirin was 73% and 64%, respectively (p<0.12-log rank test). The corresponding patient survival from vascular death in the 2 groups was 73% and 70% (p<0.67-log rank test). Crural/ pedal bypass (51/75 on aspirin) and smoking (51/61 on aspirin) were independent risk factors for graft failure and vascular death respectively whilst those with a previous myocardial infarct (21/28 on aspirin) reached significance in univariate analysis only (p< 0.03).
Conclusion:
Aspirin was not a significant factor in preventing graft failure or vascular death in patients undergoing bypass for critical limb ischemia. Dual therapy with other antiplatelet agents needs to be considered in such patients particularly those undergoing crural/pedal bypass, smokers and those with a history of previous myocardial infarction.
