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


CONCLUSIONS
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.
Curi
Michael A
MA
Section of Vascular Surgery, Department of Surgery, University of Chicago, IL 60637, USA.
Skelly
Christopher L
CL
Baldwin
Zachary K
ZK
Woo
David H
DH
Baron
Joseph M
JM
Desai
Tina R
TR
Katz
Daniel
D
McKinsey
James F
JF
Bassiouny
Hisham S
HS
Gewertz
Bruce L
BL
Schwartz
Lewis B
LB
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D007511:Ischemia / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012698:Serologic Tests; D015996:Survival Rate; D019851:Thrombophilia / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors