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Heneghan, HM,Sultan, S
Homocysteine, the Cholesterol of the 21(st) Century. Impact of Hyperhomocysteinemia on Patency and Amputation-Free Survival After Intervention for Critical Limb Ischemia
JOURNAL OF ENDOVASCULAR THERAPY
2008
August
Published
1
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homocysteine hyperhomocysteinemia peripheral vascular disease patency rates primary patency assisted primary patency secondary patency amputation-free survival mortality PLASMA HOMOCYSTEINE CARDIOVASCULAR-DISEASE HEART-DISEASE FOLIC-ACID MORTALITY REVASCULARIZATION NEPHROPATHY CAUSALITY THERAPY
399
407
Purpose: To assess the prevalence of hyperhomocysteinemia and determine any correlation to the clinical and technical outcome of peripheral arterial revascularization for critical limb ischemia (CLI).Methods: Between October 1, 2002, and December 31, 2006, 953 revascularization procedures were performed for CLI in a high-volume tertiary referral vascular/endovascular unit. Fasting plasma homocysteine was accurately measured preoperatively in 225 patients (124 men; mean age 75.8 years, range 45-98), who formed the basis for the study. All patients had multilevel disease (TASC II C and D lesions), and 73% had single vessel runoff. Composite primary endpoints included primary, assisted primary, and secondary patency; amputation-free survival; and all-cause mortality.Results: The prevalence of hyperhomocysteinemia was 30% [69 patients (36 men; mean age 78.2 years, range 53-93)]; most (88%) of the patients showed a mild elevation in homocysteine (13-20 mu mol/L). Patients with hyperhomocysteinemia had significantly lower primary, assisted primary, and secondary patency rates at all intervals to 36 months (3.3%, 10.8%, and 11.2%, respectively; p13.0 mu mol/L was found to be significantly associated with adverse outcomes, such as amputation (OR=3.4, 95% CI 1.27 to 9.01; p=0.015) and graft occlusion (OR=7.97, 95% CI 3.63 to 17.5; p<0.0001).Conclusion: Hyperhomocysteinemia appears to be an independent risk factor for the progression of vascular disease and is an adverse prognostic factor for CLI patients undergoing peripheral arterial revascularization. J Endovasc Ther 2008;15:399-407
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