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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 June;22(2):116-24


language: English

Thrombophilia and arterial disease. An up-to-date review of the literature for the vascular surgeon

Bohm G. 1, Al-Khaffaf H. 2

1 Department of Surgery, University Hospital RWTH, Aachen, Germany 2 Department of Vascular Surgery, Burnley General Hospital, Burnley, England


Throm­bo­phil­ia may be ­defined as the ten­den­cy to arte­ri­al or ­venous throm­bo­sis. Throm­bo­phil­ia can be ­acquired or hered­i­tary. ­Acquired con­di­tions lead­ing to arte­ri­al throm­bo­sis are com­mon­ly encoun­tered in vas­cu­lar sur­gi­cal prac­tice, but less well known is the poten­tial influ­ence of genet­ic fac­tors. In ­recent years, evi­dence has accu­mu­lat­ed for a cru­cial role of genet­ic fac­tors in the path­o­gen­e­sis of ­venous throm­bo­sis, many pre­vi­ous­ly ­unknown genet­ic ­defects hav­ing been recent­ly iden­ti­fied. The role of genet­ic pre­dis­po­si­tion for the path­o­gen­sis of arte­ri­al occlu­sive dis­ease on the other hand is ­unknown, ­although ­recent pub­li­ca­tions sug­gest a def­i­nite link. This may have impli­ca­tions for the vas­cu­lar sur­geon in the man­age­ment of ­patients with arte­ri­al dis­ease. A med­line ­search was per­formed in order to iden­ti­fy ­papers pub­lished ­between 1990-2002 on throm­bo­phil­ia, arte­ri­al dis­ease and periph­er­al arte­ri­al occlu­sive dis­ease (PAOD). With ­regard to ­venous throm­bo­sis we ­obtained a much wider knowl­edge about genet­ic ­defects lead­ing to throm­bo­phil­ia. This has ­altered the diag­nos­tic and ther­a­peu­tic ­approach to ­patients with ­venous throm­bo­sis, and has had an impor­tant influ­ence on coun­sel­ling and screen­ing of fam­i­ly mem­bers, espe­cial­ly ­females of child­bear­ing age. With ­regard to arte­ri­al throm­bo­sis, cer­tain throm­bo­phil­ic dis­or­ders have a def­i­nite path­o­phy­sio­log­i­cal role. Hyper­hom­o­cys­tei­nae­mia, inher­it­ed or ­acquired, has been dem­on­strat­ed to be an inde­pen­dent risk fac­tor for athe­ro-throm­bo­sis. The anti­phos­pho­lip­id anti­body syn­drome (APS), an ­acquired con­di­tion, also pre­dis­pos­es to arte­ri­al throm­bo­sis. Other throm­bo­phil­ic con­di­tions, such as pro­throm­bin gene G20210A var­i­ant or fac­tor V Leid­en, have been inves­ti­gat­ed, but cur­rent evi­dence does not unequiv­ocal­ly sup­port the hypoth­e­sis of a path­o­phy­sio­log­i­cal role in athe­ro-throm­bo­sis. Rou­tine screen­ing for throm­bo­phil­ia in ­patients with athe­ro-throm­bo­sis is there­fore not gen­er­al­ly rec­om­mend­ed on the basis of cur­rent evi­dence, but there is a role for selec­tive screen­ing.

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