Smoking and plasma fibrinogen, lipoprotein (a) and serotonin are markers for postoperative infrainguinal graft stenosis

Objectives: A number of systemic variables are associated with infrainguinal graft failure and also with experimental smooth muscle hyperplasia. Stenosis is the most common cause of infrainguinal graft thrombosis but if is not known if systemic variables are associated with stenosis. Design, materials and methods: In this study, clinical and serological factors were measured and correlated with stenosis development in 82 infrainguinal bypass grafts (52 vein, 29 PTFE; 28 with stenosis) in prospective (n=46) and retrospective (n=35) groups. Pre-existing stenosis was excluded by perioperative graft assessment. Results: There was a significantly greater proportion of smokers in the patients who developed stenosis (11/18; 61%) compared with those who did not (6/28; 21%, p = 0.006; chi(2)). Patients who developed stenosis also had significantly (Mann Whitney U-tests), higher circulating levels of [median (interquartile range)] fibrinogen (412.5 (356-484.5) vs. 339 (300-397.7) mg/100ml, p = 0.003), Lipoprotein (a) (0.20 (0.05-0.45) vs. 0.085 (0.05-0.23) g/l, p = 0.03) and 5-hydroxytryptamine (14.1 (6.6-45) vs. 4.41 (3-8.39) nmol/l, p = 0.005), than those without stenosis. By logistic regression, these associations were independent of graft material and whether grafts were studied prospectively or retrospectively. Conclusions: Smoking and plasma fibrinogen, Lp(a) and 5-hydroxytryptamine are markers for postoperative infrainguinal graft stenosis.