Long-term outcome of infrainguinal bypass grafting in patients with serologically proven hypercoagulability

Michael A. Curi, Christopher L. Skelly, Zachary K. Baldwin, David H. Woo, Joseph M. Baron, Tina R. Desai, Daniel Katz, James F. McKinsey, Hisham S. Bassiouny, Bruce L. Gewertz, Lewis B. Schwartz, Magruder C. Donaldson

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)301-306
Number of pages6
JournalJournal of Vascular Surgery
Volume37
Issue number2
DOIs
StatePublished - Feb 1 2003
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Curi, M. A., Skelly, C. L., Baldwin, Z. K., Woo, D. H., Baron, J. M., Desai, T. R., Katz, D., McKinsey, J. F., Bassiouny, H. S., Gewertz, B. L., Schwartz, L. B., & Donaldson, M. C. (2003). Long-term outcome of infrainguinal bypass grafting in patients with serologically proven hypercoagulability. Journal of Vascular Surgery, 37(2), 301-306. https://doi.org/10.1067/mva.2003.114