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Hyperhomocysteinaemia is a risk factor for vein graft stenosis
C Irvine1, Y G Wilson, I C Currie
1Department of Vascular Surgery, Bristol Royal Infirmary, U.K.
Insights
Elevated homocysteine levels (HHCA) are linked to vein graft stenosis (VGS) after infrainguinal bypass surgery. This finding suggests HHCA may be a new risk factor for VGS, aiding in identifying at-risk patients.
Area of Science:
- Vascular surgery
- Cardiovascular research
- Neointimal hyperplasia
Background:
- Infrainguinal vein graft failure often results from progressive vein graft stenosis (VGS) due to intimal hyperplasia.
- Systemic factors, including hyperhomocysteinemia (HHCA), are implicated in intimal hyperplasia development.
- HHCA is a known risk factor for coronary and peripheral arterial disease.
Purpose of the Study:
- To investigate the influence of HHCA and other serological factors on the development of VGS.
- To determine if HHCA is associated with VGS in patients undergoing infrainguinal vein bypass.
Main Methods:
- A case/control study involving 38 patients who underwent infrainguinal vein bypass.
- Nineteen patients with documented VGS were matched with controls without stenosis.
- Blinded Duplex ultrasound scans, venesection, and carbon monoxide estimation were performed.
Main Results:
- Plasma homocysteine levels were significantly elevated in patients with VGS compared to controls.
- Statistical analysis indicated a significant association between HHCA and VGS (p < 0.3).
Conclusions:
- HHCA appears to be a previously unrecognized risk factor for VGS.
- Patients with HHCA may be more susceptible to developing VGS.
- Preoperative screening for HHCA could help identify patients at increased risk for VGS.
Objectives:
Many infrainguinal vein graft failures are due to progressive vein graft stenosis (VGS) from intimal hyperplasia. Systemic factors have been implicated in the aetiology of intimal hyperplasia. Hyperhomocysteinaemia (HHCA) is established as an independent risk factor for coronary and peripheral arterial disease. The objective of this study was to examine the influence of HHCA and other serological factors upon the development of VGS.
Study Design:
Thirty-eight patients who had undergone infrainguinal vein bypass were recruited to a case/control study from a graft surveillance program. Nineteen patients with documented VGS were matched against controls without stenosis for age, sex, length of time from surgery, diabetes, smoking history and preoperative symptom score. All patients were recalled for Duplex ultrasound scans, venesection and carbon monoxide estimation which were performed in a blinded fashion.
Results:
Statistical analysis of all parameters revealed that plasma homocysteine was significantly elevated in patients with VGS (p < 0.3, Wilcoxon rank sum).
Conclusions:
These results suggest that HHCA is a previously unidentified risk factor for VGS. Patients with HHCA are susceptible to VGS and preoperative investigation would allow identification of patients at risk.