Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1989 Sep 9;299(6700):643–646. doi: 10.1136/bmj.299.6700.643

Influence of smoking and plasma factors on patency of femoropopliteal vein grafts.

S Wiseman 1, G Kenchington 1, R Dain 1, C E Marshall 1, C N McCollum 1, R M Greenhalgh 1, J T Powell 1
PMCID: PMC1837588  PMID: 2508847

Abstract

OBJECTIVE--To determine the effects of smoking, plasma lipids, lipoproteins, apolipoproteins, and fibrinogen on the patency of saphenous vein femoropopliteal bypass grafts at one year. DESIGN--Prospective study of patients with saphenous vein femoropopliteal bypass grafts entered into a multicentre trial. SETTING--Surgical wards, outpatient clinics, and home visits coordinated by two tertiary referral centres in London and Birmingham. PATIENTS--157 Patients (mean age 66.6 (SD 8.2) years), 113 with patent grafts and 44 with occluded grafts one year after bypass. MAIN OUTCOME MEASURE--Cumulative percentage patency at one year. RESULTS--Markers for smoking (blood carboxyhaemoglobin concentration (p less than 0.05) and plasma thiocyanate concentration (p less than 0.01) and plasma concentrations of fibrinogen (p less than 0.001) and apolipoproteins AI (p less than 0.04) and (a) (p less than 0.05) were significantly higher in patients with occluded grafts. Serum cholesterol concentrations were significantly higher in patients with grafts that remained patent one year after bypass (p less than 0.005). Analysis of the smoking markers indicated that a quarter of patients (40) were untruthful in their claims to have stopped smoking. Based on smoking markers, patency of grafts in smokers was significantly lower at one year by life table analysis than in non-smokers (63% v 84%, p less than 0.02). Patency was significantly higher by life table analysis in patients with a plasma fibrinogen concentration below the median than in those with a concentration above (90% v 57%, p less than 0.0002). Surprisingly, increased plasma low density lipoprotein cholesterol concentration was significantly associated with improved patency at one year (85%) at values above the median compared with patency (only 68%) at values in the lower half of the range (p less than 0.02). CONCLUSIONS--Plasma fibrinogen concentration was the most important variable predicting graft occlusion, followed by smoking markers. A more forceful approach is needed to stop patients smoking; therapeutic measures to improve patency of vein grafts should focus on decreasing plasma fibrinogen concentration rather than serum cholesterol concentration.

Full text

PDF
643

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ball M., Mann J. I. Apoproteins: predictors of coronary heart disease? Br Med J (Clin Res Ed) 1986 Sep 27;293(6550):769–770. doi: 10.1136/bmj.293.6550.769. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blankenhorn D. H., Nessim S. A., Johnson R. L., Sanmarco M. E., Azen S. P., Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA. 1987 Jun 19;257(23):3233–3240. [PubMed] [Google Scholar]
  3. Campeau L., Enjalbert M., Lespérance J., Bourassa M. G., Kwiterovich P., Jr, Wacholder S., Sniderman A. The relation of risk factors to the development of atherosclerosis in saphenous-vein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery. N Engl J Med. 1984 Nov 22;311(21):1329–1332. doi: 10.1056/NEJM198411223112101. [DOI] [PubMed] [Google Scholar]
  4. Chung B. H., Wilkinson T., Geer J. C., Segrest J. P. Preparative and quantitative isolation of plasma lipoproteins: rapid, single discontinuous density gradient ultracentrifugation in a vertical rotor. J Lipid Res. 1980 Mar;21(3):284–291. [PubMed] [Google Scholar]
  5. Durrington P. N., Ishola M., Hunt L., Arrol S., Bhatnagar D. Apolipoproteins (a), AI, and B and parental history in men with early onset ischaemic heart disease. Lancet. 1988 May 14;1(8594):1070–1073. doi: 10.1016/s0140-6736(88)91895-8. [DOI] [PubMed] [Google Scholar]
  6. Fuster V., Chesebro J. H. Role of platelets and platelet inhibitors in aortocoronary artery vein-graft disease. Circulation. 1986 Feb;73(2):227–232. doi: 10.1161/01.cir.73.2.227. [DOI] [PubMed] [Google Scholar]
  7. Gordon T., Kannel W. B., Castelli W. P., Dawber T. R. Lipoproteins, cardiovascular disease, and death. The Framingham study. Arch Intern Med. 1981 Aug;141(9):1128–1131. [PubMed] [Google Scholar]
  8. Green R. M., Ouriel K., Ricotta J. J., DeWeese J. A. Revision of failed infrainguinal bypass graft: principles of management. Surgery. 1986 Oct;100(4):646–654. [PubMed] [Google Scholar]
  9. Harris P. L., How T. V., Jones D. R. Prospectively randomized clinical trial to compare in situ and reversed saphenous vein grafts for femoropopliteal bypass. Br J Surg. 1987 Apr;74(4):252–255. doi: 10.1002/bjs.1800740409. [DOI] [PubMed] [Google Scholar]
  10. Hoff H. F., Beck G. J., Skibinski C. I., Jürgens G., O'Neil J., Kramer J., Lytle B. Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation. 1988 Jun;77(6):1238–1244. doi: 10.1161/01.cir.77.6.1238. [DOI] [PubMed] [Google Scholar]
  11. Hughson W. G., Mann J. I., Tibbs D. J., Woods H. F., Walton I. Intermittent claudication: factors determining outcome. Br Med J. 1978 May 27;1(6124):1377–1379. doi: 10.1136/bmj.1.6124.1377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Laing S. P., Greenhalgh R. M. Standard exercise test to assess peripheral arterial disease. Br Med J. 1980 Jan 5;280(6206):13–16. doi: 10.1136/bmj.280.6206.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Meade T. W., Imeson J., Stirling Y. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischaemic heart disease. Lancet. 1987 Oct 31;2(8566):986–988. doi: 10.1016/s0140-6736(87)92556-6. [DOI] [PubMed] [Google Scholar]
  14. Meade T. W., Mellows S., Brozovic M., Miller G. J., Chakrabarti R. R., North W. R., Haines A. P., Stirling Y., Imeson J. D., Thompson S. G. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet. 1986 Sep 6;2(8506):533–537. doi: 10.1016/s0140-6736(86)90111-x. [DOI] [PubMed] [Google Scholar]
  15. Miller N. E., Thelle D. S., Forde O. H., Mjos O. D. The Tromsø heart-study. High-density lipoprotein and coronary heart-disease: a prospective case-control study. Lancet. 1977 May 7;1(8019):965–968. doi: 10.1016/s0140-6736(77)92274-7. [DOI] [PubMed] [Google Scholar]
  16. Powell J. T., Sian M., Wiseman S., Greenhalgh R. M. Fibrinogen and carboxyhaemoglobin in peripheral arterial disease. Lancet. 1988 Jan 16;1(8577):121–121. doi: 10.1016/s0140-6736(88)90320-0. [DOI] [PubMed] [Google Scholar]
  17. Szilagyi D. E., Elliott J. P., Hageman J. H., Smith R. F., Dall'olmo C. A. Biologic fate of autogenous vein implants as arterial substitutes: clinical, angiographic and histopathologic observations in femoro-popliteal operations for atherosclerosis. Ann Surg. 1973 Sep;178(3):232–246. doi: 10.1097/00000658-197309000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Walton K. W., Slaney G., Ashton F. Atherosclerosis in vascular grafts for peripheral vascular disease. Part 1. Autogenous vein grafts. Atherosclerosis. 1985 Jan;54(1):49–64. doi: 10.1016/0021-9150(85)90153-4. [DOI] [PubMed] [Google Scholar]
  19. Whittemore A. D., Clowes A. W., Couch N. P., Mannick J. A. Secondary femoropopliteal reconstruction. Ann Surg. 1981 Jan;193(1):35–42. doi: 10.1097/00000658-198101000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Whittemore A. D., Couch N. P., Mannick J. A. Treatment of arterial occlusive disease of the lower extremities. Annu Rev Med. 1985;36:505–514. doi: 10.1146/annurev.me.36.020185.002445. [DOI] [PubMed] [Google Scholar]
  21. Wilhelmsen L., Svärdsudd K., Korsan-Bengtsen K., Larsson B., Welin L., Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med. 1984 Aug 23;311(8):501–505. doi: 10.1056/NEJM198408233110804. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES