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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 September;22(3):302-7


language: English

The efficacy of aspirin in patients undergoing infra-inguinal bypass and identification of high risk patients

Mahmood A., Sintler M., Edwards A. T., Smith S. R. G., Simms M. H., Vohra R. K.

Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK


Aim. Infra­in­gui­nal ­bypass is an effec­tive treat­ment for crit­i­cal lower limb ische­mia but up to 1/3 of these ­grafts will ­occlude with­in the 1st year. The aim of this audit was to eval­u­ate the effi­ca­cy of aspi­rin in main­tain­ing graft paten­cy and also improv­ing ­patient sur­vi­val.
Meth­ods. In a sin­gle aud­it­ed year (1997) 125 bypass­es were car­ried out. Sev­en­ty-nine were on aspi­rin, 34 on no treat­ment and 12 were on other ­agents and hence exclud­ed from anal­y­sis.The indi­ca­tion for sur­gery was crit­i­cal ischae­mia in 101 and dis­abling claud­i­ca­tion in 12. Autol­o­gous vein was used in 104 and pros­thet­ic ­grafts in 9.
­Results. The over­all 2-year pri­mary graft paten­cy, sec­on­dary graft paten­cy and limb sal­vage were 50%, 71% and 83%, respec­tive­ly. The 2-year sec­on­dary paten­cy in ­patients with or with­out aspi­rin was 73% and 64%, respec­tive­ly (p<0.12-log rank test). The cor­re­spond­ing ­patient sur­vi­val from vas­cu­lar death in the 2 ­groups was 73% and 70% (p<0.67-log rank test). Cru­ral/ pedal ­bypass (51/75 on aspi­rin) and smok­ing (51/61 on aspi­rin) were inde­pen­dent risk fac­tors for graft fail­ure and vas­cu­lar death respec­tive­ly ­whilst those with a pre­vi­ous myo­car­dial ­infarct (21/28 on aspi­rin) ­reached sig­nif­i­cance in uni­var­i­ate anal­y­sis only (p< 0.03).
Con­clu­sion. Aspi­rin was not a sig­nif­i­cant fac­tor in pre­vent­ing graft fail­ure or vas­cu­lar death in ­patients under­go­ing ­bypass for crit­i­cal limb ische­mia. Dual ther­a­py with other antiplate­let ­agents needs to be con­sid­ered in such ­patients par­tic­u­lar­ly those under­go­ing cru­ral/pedal ­bypass, smok­ers and those with a his­to­ry of pre­vi­ous myo­car­dial infarc­tion.

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