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

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.