Relationship between antiphospholipid antibodies and progression of lower extremity arterial occlusive disease after lower extremity bypass operations

Purpose: Antiphospholipid antibodies (APLs), which consist of anticardiolip in antibodies (ACLs) or lupus anticoagulant (LA), are associated with venou s thrombosis, stroke, and cardiac events. Although they are present in many patients with lower extremity atherosclerotic occlusive disease (LEAOD), t he relationship between APL and the progression of LEAOD has not been repor ted. A comparison of progression of LEAOD as determined with direct imaging studies in patients with and without APL forms the basis for this report. Methods: APL+ patients (immunoglobulin M [IgM] or IgA or IgG ACL > 3 SD uni ts above control mean or positive LA) who underwent lower extremity bypass grafting between January 1990 and June 1999 (n = 79) were compared with an APL control group (n = 68). Members of the study and control groups were si milar with respect to age, procedure, sex, length of follow-up, and multipl e atherosclerosis risk factors. Progression of LEAOD was determined by comp aring preoperative arteriograms with postoperative imaging studies (arterio grams or duplex scanning). External iliac, common femoral, superficial femo ral and popliteal arteries were graded as < 50% stenosis, greater than or e qual to 50% stenosis, or occluded. Posterior tibial and anterior tibial art eries were graded as patent or occluded. Progression was defined as any inc rease in stenosis category. Results: The mean follow-up period was 31 months for APL+ and 35 months for APL- patients (P = not significant). Progression of LEAOD occurred in 58 ( 73%) of 79 APL+ patients and in 25 (37%) of 68 APL patients (P < .001). The re was no difference in progression in external iliac or common femoral art eries. Differences in progression were noted in more distal arteries; APLpatients had significantly more progression in superficial femoral (45% vs 16%, P < .01), popliteal (31% vs 12%, P < .01), posterior tibial (2996 vs 1 3%, P < .05), and anterior tibial arteries (29% vs 14%, P < .05). Multivari ate logistic regression analysis showed a significant independent associati on between the presence of APL and progression of LEAOD (P < .0001). Conclusion: In this study, the presence of APL in patients undergoing lower extremity bypass operations was a significant independent risk factor for progression of LEAOD. We conclude that this patient group should be closely monitored in the postoperative period and appears ideally suited for prosp ective studies of therapies to modify LEAOD progression.