Homocysteine levels, haemostatic risk factors and patency rates after endovascular treatment of the above-knee femoro-popliteal artery.
OBJECTIVE
To investigate the relationship between plasma homocysteine and other haemostatic variables and restenoses or reocclusions after endovascular treatment of symptomatic atherosclerosis of the above-knee femoro-popliteal artery.


METHODS
Prospective observational study.


METHODS
University hospital.


METHODS
The study included 103 patients (116 limbs), treated with subintimal angioplasty in 58 cases (50%) and with intraluminal PTA in 58 (50%): 39 (34%) patients were treated for critical limb ischaemia. Blood samples for analyses of fasting plasma values of homocysteine, fibrinogen, D-dimer, activated protein C resistance were drawn upon admission. Median follow-up for all procedures was 11 months (range 0-42 months). Outcome events (arterial patency) were defined as > or =50% restenosis or reocclusion in the treated arterial segment. Patency rates were estimated with the product limit method and Kaplan-Meier curves. Variables found to be related significantly to patency were included in multivariate analysis performed with the Cox proportional hazard model.


RESULTS
The 1-year cumulative primary patency rate for all procedures was 48%. One-year limb salvage rate in cases of critical ischaemia was 74%. Multivariate analysis demonstrated significant independent associations between patency rates and plasma D-dimer, diabetes mellitus, the nature of the lesion treated (stenosis vs. occlusion) and antithrombotic therapy with aspirin after the procedure. Plasma levels of homocysteine, fibrinogen or activated protein C resistance were not associated with patency rates. Homocysteine levels were higher in patients with critical limb ischaemia than those with intermittent claudication.


CONCLUSIONS
Early restenosis or reocclusion after endovascular intervention of lesions in the above-knee femoro-popliteal artery was more frequent following treatment of occlusion (versus stenosis), for patients with diabetes, patients with elevated D-dimer and those without antithrombotic therapy after the procedure. Plasma homocysteine did not appear to influence the outcome of endovascular intervention.
Laxdal
E
E
Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway.
Eide
G E
GE
Wirsching
J
J
Jenssen
G L
GL
Jonung
T
T
Pedersen
G
G
Amundsen
S R
SR
Dregelid
E
E
Aune
S
S
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D005260:Female; D005263:Femoral Artery / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D006487:Hemostasis / Q000502:physiology*; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D007717:Knee / Q000098:blood supply* / Q000503:physiopathology; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D011150:Popliteal Artery / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013223:Statistics as Topic; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D014656:Vascular Surgical Procedures
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D006710:Homocysteine; D005340:Fibrinogen