J Korean Soc Vasc Surg.  2011 Feb;27(1):14-18.

The Effects of the Preoperative Serum Homocysteine Level on Restenosis after Infraninguinal Bypass Surgery or Endovascular Surgery for Peripheral Arterial Disease

• Kim SH
• Kwon OJ

Abstract

PURPOSE
Hyperhomocysteinemia is accepted as an independent risk factor for peripheral arterial disease (PAD). The purpose of this study is to evaluate the correlation between the preoperative plasma homocysteine concentration and restenosis after therapeutic revascularization.
METHODS
We retrospectively analyzed the clinical records of 58 consecutive patients (they were confined to Trans Atlantic Inter-Society Consensus [TASC] type C & D) among 103 patients who were diagnosed as having infrainguinal PAD and who were treated with bypass surgery or endovascular surgery from July 2003 to July 2009. We analyzed the effect of several factors such as gender, age, the plasma lipid profile and the protein C, protein S, fibrinogen, C-reactive protein, diabetes mellitus, hypertension, ankle-brachial index (ABI), and homocysteine levels, which are all considered to be risk factors for restenosis. Multivariate and univariate analyses were performed to assess the effect of possible confounders.
RESULTS
The subjects were 50 men and 8 women (mean age: 63.8+/-10.9). There were 33 (56.9%) cases of bypass surgery and 25 (43.1%) cases of endovascular surgery. Of them, 19 cases (32.8%) showed restenosis after revascularization. In the patients with restenosis, 18 cases (94.7%) showed a preoperative high plasma homocysteine level and 1 case (5.2%) showed a normal level. A lower ABI and hyperhomocysteinemia were significantly more common in the patients with restenosis (P=0.025, P<0.001). There were no significant differences of the other factors, except for the plasma homocysteine level on multivariate analysis (P=0.001).
CONCLUSION
We can regard the preoperative hyperhomocysteinemia level as a predictive marker of restenosis after revascularization. Special attention may need to be given to the patients who have a lower preoperative ABI and hyperhomocysteinemia after revascularization.

Keyword

Peripheral arterial disease; Restenosis; Hyperhomocysteinemia

MeSH Terms

Ankle Brachial Index
C-Reactive Protein
Consensus
Diabetes Mellitus
Female
Fibrinogen
Homocysteine
Humans
Hyperhomocysteinemia
Hypertension
Male
Multivariate Analysis
Peripheral Arterial Disease
Plasma
Protein C
Protein S
Retrospective Studies
Risk Factors
C-Reactive Protein
Fibrinogen
Homocysteine
Protein C
Protein S