Ch. Timaran et al., Influence of hormone replacement therapy on graft patency after femoropopliteal bypass grafting, J VASC SURG, 32(3), 2000, pp. 506-516
Citations number
39
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: Thromboembolic events are more frequent in women with establishe
d cardiovascular disease who are receiving hormone replacement therapy (HRT
). The effect of HRT on the outcome of women undergoing infrainguinal bypas
s grafting is unknown. The purpose of this study was to estimate the influe
nce of risk factors, in particular HRT, on the outcome of women undergoing
femoropopliteal bypass grafting.
Methods: During a 5-year period (between 1993 and 1998), 131 femoropoplitea
l bypass graft procedures were performed in 106 women. The criteria prepare
d by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surg
ery/North American Chapter of the International Society for Cardiovascular
Surgery) were followed. Both univariate (Kaplan-Meier method) and multivari
ate analyses (Cox proportional hazards model) were used to determine the as
sociation among preoperative variables, graft patency, limb salvage, and su
rvival.
Results: The average age of the patients was 66.4 years; 26% of the patient
s were receiving HRT. Indications for femoropopliteal bypass grafting were
limb salvage (80%) and disabling claudication (20%). Autogenous vein was us
ed in 48% of procedures, polytetrafluoroethylene (PTFE) in 49%, and PTFE-ve
in composite grafts in 3%. Distal popliteal anastomosis was above the knee
in 52% and below the knee in 48%. Overall primary patency rate was 81% at 1
year, 65% at 3 years, and 56% at 5 years. Primary patency rates at 1, 3, a
nd 5 years were 75%, 45%, and 23%, respectively, for HRT users and 84%, 72%
, and 65%, respectively, for nonusers of HRT. Overall, cumulative 1- and 5-
year limb salvage results were 96% and 92%, respectively, and long-term sur
vival at 1, 3, and 5 years was 96%, 86% and 74%, respectively. With univari
ate and Cox regression analyses, HRT was identified as the only independent
predictor of reduced primary graft patency (Kaplan-Meier method, log-rank
test, P = .004; relative risk, 2.5; 95% CI, 1.3-4.8). Women receiving HRT w
ho underwent a procedure with PTFE had the lowest primary graft patency rat
es (relative risk, 3.4; 95% CI, 1.5-7.8; P = .006).
Conclusions: Women undergoing femoropopliteal bypass graft procedures who a
re receiving HRT have significantly reduced primary graft patency rates. Th
e risk of graft failure increases when prosthetic materials are used.