Preoperative d-ROMs as a Biomarker for Predicting Graft Failure After Distal Bypass Surgery in CLTI Patients

Abstract

Autologous vein graft is one of reliable conduit; however, intimal hyperplasia (IH) is the main cause of vein graft failure after bypass surgery. If we can predict the IH before bypass surgery, we may perform appropriate revascularization, and serve better life prognosis for patients with chronic limb-threatening ischemia (CLTI). The aim of this study was to clarify the biomarker for predicting IH development preoperatively. This prospective study included 69 patients (73 limbs) who underwent infrainguinal bypass surgery for CLTI between April 2016 and June 2018 in single center (73% diabetes and 46% dialysis). Various factors associated with graft failure due to IH development were analyzed by the Cox proportional hazard model. IH was defined by angiogram (computed tomography scan or digital subtraction angiography; >75% stenosis) or peak systolic velocity of greater than 3.0 m/s by duplex ultrasound surveillance. There were 43 (59%) patients with WIfI stage 4 disease and there was significant difference in d-ROMs (as oxidative stress marker) by WIfI stage (stage 3, n = 295 vs stage 4, n =346; P = .034). Fifty-two (71%) grafts were patent (P group) and IH was occurred in 21 (29%) grafts (IH group). Forty-eight grafts (65%) were of poor quality and primary graft patency was 69% at 1 year and 63% at 2 years. There were significant differences in d-ROMs (P, n = 308 vs IH, n = 366; P = .027) and poor graft quality (P, n = 29 vs IH, n = 19; P = .041) between the two groups. Multivariate analysis demonstrated two statistically significant predictors of high d-ROMs in IH group (cut off, 316; area under the curve, 0.63): female (odds ratio, 0.152; 95% confidence interval, 0.041-0.569; P = .005), poor graft quality (odds ratio, 5.195; 95% confidence interval, 1.33-20.25; P = .018). This study suggested that oxidative stress and graft quality strongly correlates graft patency in patients with CLTI and d-ROMs may become a biomarker for predicting IH development preoperatively.