ANTIBODIES TO CARDIOLIPIN MAY INCREASE THE RISK OF FAILURE OF PERIPHERAL VEIN BYPASSES

Objectives: To assess the association between antibodies to cardiolipi n and infrainguinal vein graft patency. Materials and Methods: Plasma levels of antibodies to cardiolipin, haemostatic factors, lipids and t he smoking marker carboxyhaemoglobin were determined preoperatively an d 6 weeks postoperatively in 80 patients undergoing infrainguinal vein bypass surgery. Bypass patency seas 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 veloc ity by a factor of 2.5 or more was considered to indicate a significan t stenosis. Results: Antibodies to cardiolipin were identified in seve n (9%) patients preoperatively. In four Of these seven patients the by passes thrombosed within 3 months after surgery and another two develo ped stenoses. At 6 months the primary bypass patency, i.e. patency wit hout stenosis, was 14% (95% confidence interval (CII 0-33%) in patient s 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 Co x regression analysis showed that both the presence of antibodies anti bodies to cardiolipin and diabetes independently contributed towards p redicting the overall risk of bypass failure. Conclusion: Antibodies t o cardiolipin were identified in 9% of patients undergoing infrainguin al vein bypass surgery and appeared to be associated with increased ri sk of bypass failure.