Perioperative use of eicosapentaenoic acid and patency of infrainguinal vein bypass: A retrospective chart review.

UNLABELLED Abstract. BACKGROUND A significant proportion of autogenous vein grafts fail in the long term. Currently, there is no treatment to improve graft patency. OBJECTIVE This study was designed to assess the effectiveness of eicosapentaenoic acid (EPA) to prevent late failure of an autogenous vein graft and other perioperative risk factors affecting long-term patency. METHODS A retrospective chart review was performed on grafts of patients who underwent infrainguinal bypass surgery using autogenous vein grafts for peripheral arterial disease in a lower limb. Patients were stratified by the perioperative use of EPA. The EPA group was those patients who administered EPA ≥1 time within 3 months of surgery. The non-EPA group was made up of those patients who did not administer EPA within 3 months of surgery. Primary, assisted primary, and secondary patency rates of the grafts in each group were calculated by the Kaplan-Meier method and compared by the log-rank test. To evaluate the effect of other perioperative risk factors, a Cox proportional hazards analysis was performed. RESULTS One hundred sixty-one grafts were analyzed from 159 patients who underwent surgery between July 1991 and July 2005. The primary patency rates of the EPA and non-EPA groups were 93% and 86%, 89% and 74%, and 83% and 68% at 1, 3, and 5 years, respectively. In terms of primary patency, the EPA group was significantly better than the non-EPA group (P=0.042). There was no significant difference between the groups in either assisted primary or secondary patency. A Cox proportional hazard analysis found that the minimum graft diameter and perioperative use of EPA were significant factors for primary patency (P=0.002 and P=0.004, respectively). Graft diameter was the only significant factor for assisted primary and secondary patency (P=0.021 and P=0.003, respectively). CONCLUSION Although graft diameter was the most important factor for long-term patency of infrainguinal vein bypass grafts, the perioperative use of EPA significantly improved primary patency among these subjects.