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Rivista di Angiologia

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

lingua: Inglese

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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