Smoking and plasma fibrinogen, lipoprotein (a) and serotonin are markers for postoperative infrainguinal graft stenosis.
OBJECTIVE
A number of systemic variables are associated with infrainguinal graft failure and also with experimental smooth muscle hyperplasia. Stenosis is the most common cause of infrainguinal graft thrombosis but it is not known if systemic variables are associated with stenosis.


METHODS
In this study, clinical and serological factors were measured and correlated with stenosis development in 81 infrainguinal bypass grafts (52 vein, 29 PTFE; 28 with stenosis) in prospective (n=46) and retrospective (n=35) groups. Pre-existing stenosis was excluded by perioperative graft assessment.


RESULTS
There was a significantly greater proportion of smokers in the patients who developed stenosis (11/18; 61%) compared with those who did not (6/28; 21%, p=0.006; chi 2). Patients who developed stenosis also had significantly (Mann Whitney U-tests), higher circulating levels of [median (interquartile range)] fibrinogen (412.5 (356-484.5) vs. 339 (300-397.7) mg/100ml, p=0.003), Lipoprotein (a) (0.20 (0.05-0.45) vs. 0.085 (0.05-0.23) g/l, p=0.03) and 5-hydroxytryptamine (14.1 (6.6-45) vs. 4.41 (3-8.39) nmol/l, p=0.005), than those without stenosis. By logistic regression, these associations were independent of graft material and whether grafts were studied prospectively or retrospectively.


CONCLUSIONS
Smoking and plasma fibrinogen, Lp(a) and 5-hydroxytryptamine are markers for postoperative infrainguinal graft stenosis.
Cheshire
N J
NJ
St Mary's Hospital, Paddington, London, U.K.
Wolfe
J H
JH
Barradas
M A
MA
Chambler
A W
AW
Mikhailidis
D P
DP
D001807:Blood Vessel Prosthesis; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005340:Fibrinogen / Q000032:analysis*; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D016015:Logistic Models; D008297:Male; D010979:Platelet Function Tests; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012701:Serotonin / Q000097:blood*; D012907:Smoking / Q000453:epidemiology*; D018616:Ultrasonography, Doppler, Duplex; D014680:Veins / Q000637:transplantation
D017270:Lipoprotein(a); D012701:Serotonin; D005340:Fibrinogen; D011138:Polytetrafluoroethylene