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Hypercoagulable abnormalities and postoperative failure of arterial reconstruction
S A Ray1, M R Rowley, D H Bevan
1Department of Vascular Surgery, St. George's Hospital Medical School, London, U.K.
Summary
Preoperative hypercoagulable abnormalities, including lupus anticoagulant, are common in patients undergoing arterial revascularization for leg ischemia. These clotting disorders independently predict graft failure and reocclusion.
Area of Science:
- Vascular Surgery
- Hematology
- Clinical Medicine
Background:
- Peripheral arterial disease often necessitates arterial reconstruction.
- Graft failure remains a significant complication, impacting patient outcomes.
- Preoperative hypercoagulable states may contribute to graft failure.
Purpose of the Study:
- To investigate if preoperative hypercoagulable abnormalities are independent risk factors for arterial reconstruction failure in patients with leg ischemia.
- To assess the association between specific clotting factor levels and graft patency.
Main Methods:
- Prospective study of 60 patients undergoing elective peripheral revascularization.
- Preoperative and serial postoperative measurements of Antithrombin III, protein C, protein S, and lupus anticoagulant.
- Investigation of heparin-associated thrombocytopenia if indicated.
Main Results:
- Hypercoagulable abnormalities were found in 35% of patients, significantly higher (65%) in those with failed reconstructions.
- Lupus anticoagulant was more frequent with prosthetic grafts and predicted reocclusion (67% positive predictive value).
- Low preoperative protein S levels were associated with all three postoperative deaths.
Conclusions:
- Preoperative hypercoagulable abnormalities are prevalent before arterial revascularization.
- These clotting disorders are independently associated with subsequent arterial reconstruction failure.
- Identifying and managing hypercoagulable states may improve outcomes in peripheral revascularization.