Antibodies to cardiolipin may increase the risk of failure of peripheral vein bypasses.
OBJECTIVE
To assess the association between antibodies to cardiolipin and infrainguinal vein graft patency.


METHODS
Plasma levels of antibodies to cardiolipin, haemostatic factors, lipids and the smoking marker carboxyhaemoglobin were determined preoperatively and 6 weeks postoperatively in 80 patients undergoing infrainguinal vein bypass surgery. Bypass patency was assessed by ankle blood pressure measurements and ultrasound duplex scanning at 1 week, 6 weeks, 3, 6, 9 and 12 months. A localised increase in the graft peak systolic velocity by a factor of 2.5 or more was considered to indicate a significant stenosis.


RESULTS
Antibodies to cardiolipin were identified in seven (9%) patients preoperatively. In four of these seven patients the bypasses thrombosed within 3 months after surgery and another two developed stenoses. At 6 months the primary bypass patency, i.e. patency without stenosis, was 14% (95% confidence interval (CI) 0-33%) in patients with antibodies to cardiolipin, as opposed to 57% (95% CI 45-69%) in patients without these antibodies (log rank test: p = 0.03). Diabetes mellitus was also associated with a reduced 6 months primary bypass patency (38% (95% CI 16-60%) vs. 58% (95% CI 45-71%), p = 0.006). A Cox regression analysis showed that both the presence of antibodies to cardiolipin and diabetes independently contributed towards predicting the overall risk of bypass failure.


CONCLUSIONS
Antibodies to cardiolipin were identified in 9% of patients undergoing infrainguinal vein bypass surgery and appeared to be associated with increased risk of bypass failure.
Nielsen
T G
TG
Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark.
Nordestgaard
B G
BG
von Jessen
F
F
Andreasen
J J
JJ
Wiik
A
A
Heegaard
N H
NH
Schroeder
T V
TV
D000368:Aged; D017153:Antibodies, Anticardiolipin / Q000097:blood*; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007866:Leg / Q000098:blood supply; D017270:Lipoprotein(a) / Q000097:blood; D008077:Lipoproteins, LDL / Q000276:immunology; D008297:Male; D016491:Peripheral Vascular Diseases / Q000276:immunology / Q000601:surgery*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency
D017153:Antibodies, Anticardiolipin; D017270:Lipoprotein(a); D008077:Lipoproteins, LDL