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The influence of fibrinogen concentration on the development of vein graft stenoses
R C Hicks1, M Ellis, R Mir-Hasseine
1Department of Surgery, Charing Cross & Westminster Medical School, London, U.K.
Insights
High fibrinogen levels significantly increase the risk of vein graft stenosis after bypass surgery. Lowering fibrinogen may help maintain graft patency and prevent complications.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Biomarkers in Atherosclerosis
Background:
- Distal vein bypass surgery is crucial for limb salvage.
- Graft stenosis is a major cause of bypass failure.
- Identifying pre-operative risk factors is essential for improving outcomes.
Purpose of the Study:
- To identify factors associated with vein graft stenosis within the first year post-bypass.
- To evaluate the impact of various clinical and biochemical parameters on graft patency.
Main Methods:
- Prospective surveillance of 79 distal vein bypass grafts using color flow Doppler ultrasonography.
- Data collection included anastomosis site, graft type, clinical history, and biochemical markers (fibrinogen, lipids, smoking markers).
- Statistical analysis, including multiple regression and life table analysis, was used to identify significant risk factors.
Main Results:
- 32% of grafts developed stenosis within the first year.
- Graft stenosis was not associated with sex, diabetes, anastomosis site, graft type, or serum lipids.
- Elevated fibrinogen concentration was the only significant predictor of vein graft stenosis (p=0.003).
- Patients with above-median fibrinogen had significantly lower graft patency rates compared to those with below-median levels.
Conclusions:
- Increased plasma fibrinogen concentration is a potent risk factor for vein graft stenosis.
- Fibrinogen may play a role in smooth muscle cell proliferation, contributing to stenotic lesion development.
- Consideration should be given to managing fibrinogen levels to improve bypass graft outcomes.
Objective:
The aim of this study was to identify factors associated with the development of graft stenoses in the first year after bypass.
Design And Setting:
Between January 1992 and April 1993, 75 consecutive patients undergoing distal vein bypass surgery were entered into a graft surveillance programme at Charing Cross Hospital. The grafts (n = 79) were surveyed by colour flow Doppler ultrasonography at 7 days, 3, 6, 9 and 12 months and the site of stenoses (> 50%) recorded. Position of the distal anastomosis, graft type (in situ or reverse) and clinical history were recorded. At the 3-month surveillance a blood sample was taken for the estimation of smoking markers, lipids and fibrinogen.
Results:
The site of the distal anastomosis was to the suprageniculate popliteal in nine, infrageniculate popliteal in 32 and tibio/peroneal vessels in 38 cases. In the first month following bypass there were six deaths, giving a 30 day mortality of 7.5%, three patients were lost to follow up, seven grafts occluded, three were replaced by PTFE, four patients underwent amputation and one patient had a redo vein graft. In the remaining grafts 20/63 (32%) developed stenoses within the first year after bypass. The development of a graft stenosis was not associated with sex, diabetic status, site of distal anastomosis, graft type or serum lipids. Multiple regression analysis identified only one factor associated significantly with the development of vein graft stenosis: fibrinogen concentration (p = 0.003). Life table analysis showed that after 1 year only 46% of grafts remained free of stenoses in patients with above median fibrinogen concentrations compared with 84% of grafts in patients with below median fibrinogen concentrations, p = 0.009.
Conclusions:
Increased plasma fibrinogen concentration is a potent risk factor for the development of vein graft stenosis. These results prompt consideration of the role of fibrinogen in stimulating smooth muscle cell proliferation in the stenotic lesion.