Factors associated with primary vein graft occlusion in a multicenter trial with mandated ultrasound surveillance

SummaryTo assess the optimal level of oral anticoagulation to prevent occlusion of vein coronary bypass grafts, 318 patients from a graft patency trial were analysed retrospectively. Oral anticoagulant therapy was started one day before surgery and continued for one year, after which graft occlusion was assessed by angiography. The aimed level of anticoagulation was 2.8-1.8 International Normalized Ratio (INR). Clinical outcome was assessed by the incidence of myocardial infarction, thrombosis and major bleeding.The observed anticoagulation level was 2.8-4.8 INR for 54%, and 1.8-3.8 INR for 75% of time per patient. Occlusion rates in patients who spent <35, 35-70, and ≥70% of time within INR range 2.8-1.8 were 10.5%, 10.8% and 11.8%, respectively (differences not statistically significant). Patients who spent ≥70% of time within INR range 1.8-3.8 versus 2.8-4.8 showed comparable occlusion rates. The risk of graft occlusion was not related to quality of anticoagulation early (0-3 months) or late (3-12 months) after surgery. Myocardial infarction, thrombosis and major bleeding occurred in 1.3%, 2.0% and 2.9% of patients.To maintain vein graft patency in the first postoperative year by oral anticoagulation, a level within INR range 1.8-3.8 for ≥70% of time seems to be sufficient.

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Follow-up results after interventional treatment of infarct-related saphenous vein graft occlusion

Coronary Artery Disease ◽

10.1097/mca.0b013e328332ee4b ◽

2010 ◽

Vol 21 (2) ◽

pp. 61-64 ◽

Cited By ~ 6

Author(s):

Rainer Hoffmann ◽

Giadino Nitendo ◽

Verena Deserno ◽

Umar Adamu ◽

Mohammed Almalla ◽

...

Keyword(s):

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Interventional Treatment ◽

Graft Occlusion

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Abstract 2213: Characteristics of Aspirin Non-Responders: Results from the Aspirin Resistance Testing and Initial Strategy for Treatment (ARTIST) Multicenter Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_481-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Lori B Daniels ◽

Paul Clopton ◽

W. F Peacock ◽

Richard Nowak ◽

Alex Harrison ◽

...

Keyword(s):

Clinical Characteristics ◽

Multicenter Trial ◽

Aspirin Resistance ◽

Resistance Testing ◽

Lower Prevalence ◽

Therapeutic Implications ◽

Factors Associated ◽

Coronary Syndrome ◽

Initial Strategy ◽

History Of

Introduction: Aspirin (ASA) therapy reduces the risk of thrombotic events by inhibiting platelet aggregation, however some individuals have a diminished response to ASA. The ability to predict ASA non-responsiveness has important therapeutic implications. We studied patients with suspected acute coronary syndrome (ACS) to determine the characteristics of patients with ASA non-responsiveness. Methods: We enrolled 1010 patients with suspected ACS in the emergency departments (ED’s) of 5 sites. All subjects were on outpatient ASA therapy or received ASA in the ED, and were excluded if on clopidogrel. Blood was tested for ASA non-responsiveness (defined as ASA reactive units ≥ 550) on a VerifyNow® (Accumetrics) device. Results: Overall prevalence of ASA non-responsiveness was 10.3% (95% C.I. 8.6–12.3%). Responsiveness to ASA did not differ by age or sex, but varied significantly by race. Hispanics had a higher prevalence of ASA non-responsiveness, while whites and Asians had a lower prevalence ( Figure ). Other factors associated with increased prevalence of ASA resistance included outpatient ASA therapy (p<0.001), a history of alcohol (p=0.045) or drug abuse (p=0.02), a history of heart failure (p=0.01), and renal insufficiency (p=0.003). Patients with ASA non-responsiveness had lower BMI (p=0.006) and hemoglobin (p<0.001), and higher BNP levels (p<0.001), prothrombin time (p=0.01), and partial thromboplastin time (p<0.001). Conclusions: Among suspected ACS patients, the prevalence of ASA non-responsiveness varies by race and is highest in Hispanics. ASA resistance is also more prevalent in patients with clinical characteristics consistent with poorer health. Prevalence of ASA Non-Responsiveness by Race

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Preoperative and intraoperative predictors of saphenous vein graft occlusion after coronary bypass surgery

Journal of the American College of Cardiology ◽

10.1016/0735-1097(91)91445-k ◽

1991 ◽

Vol 17 (2) ◽

pp. A120

Author(s):

G.V.R.K. Sharma ◽

Gulshan Sethi ◽

Tom Moritz ◽

Diane Lapsley ◽

Shukri Khuri ◽

...

Keyword(s):

Saphenous Vein ◽

Vein Graft ◽

Bypass Surgery ◽

Saphenous Vein Graft ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Graft Occlusion

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Lipoprotein(a) and cell adhesion molecules as predictors of vein graft occlusion in post-cabg patients receiving lipoprotein apheresis

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.05.155 ◽

2014 ◽

Vol 235 (2) ◽

pp. e62

Author(s):

R. Adzhiev ◽

M. Ezhov ◽

M. Safarova ◽

M. Afanasieva ◽

Y. Berestetskaya ◽

...

Keyword(s):

Cell Adhesion ◽

Adhesion Molecules ◽

Vein Graft ◽

Cell Adhesion Molecules ◽

Graft Occlusion ◽

Lipoprotein A ◽

Lipoprotein Apheresis ◽

Cabg Patients

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Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass

Vascular ◽

10.1177/1708538117717141 ◽

2017 ◽

Vol 26 (2) ◽

pp. 117-125 ◽

Cited By ~ 3

Author(s):

Jeremy Kaisar ◽

Aaron Chen ◽

Mathew Cheung ◽

Elias Kfoury ◽

Carlos F Bechara ◽

...

Keyword(s):

Limb Salvage ◽

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Artery Bypass ◽

Length Of Hospital Stay ◽

Primary Patency ◽

Secondary Patency ◽

Graft Occlusion ◽

Tibial Artery

Introduction Heparin-bonded expanded polytetrafluoroethylene grafts (Propaten, WL Gore, Flagstaff, AZ, USA) have been shown to have superior patency compared to standard prosthetic grafts in leg bypass. This study analyzed the outcomes of Propaten grafts with distal anastomotic patch versus autogenous saphenous vein grafts in tibial artery bypass. Methods A retrospective analysis of prospective collected data was performed during a recent 15-year period. Sixty-two Propaten bypass grafts with distal anastomotic patch (Propaten group) were compared with 46 saphenous vein graft (vein group). Pertinent clinical variables including graft patency and limb salvage were analyzed. Results Both groups had similar clinical risk factors, bypass indications, and target vessel for tibial artery anastomoses. Decreased trends of operative time (196 ± 34 min vs. 287 ± 65 min, p = 0.07) and length of hospital stay (5.2 ± 2.3 days vs. 7.5 ± 3.6, p = 0.08) were noted in the Propaten group compared to the vein group. Similar primary patency rates were noted at four years between the Propaten and vein groups (85%, 71%, 64%, and 57%, vs. 87%, 78%, 67%, and 61% respectively; p = 0.97). Both groups had comparable secondary patency rates yearly in four years (the Propaten group: 84%, 76%, 74%, and 67%, respectively; the vein group: 88%, 79%, 76%, and 72%, respectively; p = 0.94). The limb salvage rates were equivalent between the Propaten and vein group at four years (84% vs. 92%, p = 0.89). Multivariate analysis showed active tobacco usage and poor run-off score as predictors for graft occlusion. Conclusions Propaten grafts with distal anastomotic patch have similar clinical outcomes compared to the saphenous vein graft in tibial artery bypass. Our data support the use of Propaten graft with distal anastomotic patch as a viable conduit of choice in patients undergoing tibial artery bypass.

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