HYPERHOMOCYSTEINAEMIA IS A RISK FACTOR FOR VEIN GRAFT STENOSIS

Objectives: Many infrainguinal vein graft failures are due to progress ive vein graft stenosis (VGS) from intimal hyperplasia. Systemic facto rs have been implicated in the aetiology of intimal hyperplasia. Hyper homocysteinaemia (HHCA) is established as an independent risk factor f or coronary and peripheral arterial disease. The objective of this stu dy was to examine the influence of HHCA and other serological factors upon the development of VGS. Study design: Thirty-eight patients who h ad undergone infrainguinal vein bypass were recruited to a case/contro l study from a graft surveillance program. Nineteen patients with docu mented VGS were matched against controls without stenosis for age, sex length of time from surgery, diabetes, smoking history and preoperati ve symptom score. All patients were recalled for Duplex ultrasound sca ns, venesection and carbon monoxide estimation which were performed in a blinded fashion. Results: Statistical analysis of all parameters re vealed that plasma homocysteine was significantly elevated in patients with VGS (p < 0.3, Wilcoxon rank sum). Conclusions: These results sug gest that HHCA is a previously unidentified risk factor for VGS. Patie nts with HHCA are susceptible to VGS and preoperative investigation wo uld allow identification of patients at risk.