Homocysteine Levels, Haemostatic Risk Factors and Patency Rates After Endovascular Treatment of the Common Iliac Arteries

Abstract 

Objectives

To investigate the impact of clinical risk factors, plasma homocysteine and haemostatic variables on the results after endovascular treatment of symptomatic atherosclerosis of the common iliac artery.

Design

Prospective observational study.

Setting

University hospital.

Patients and method

The study included 139 technically successful interventions in 103 patients. Technical success was defined as ≤30% residual stenosis as seen on the post treatment angiogram. Blood samples for analyses of fasting plasma values of homocysteine, fibrinogen, D-dimer, activated protein C resistance were drawn upon admission. Median follow-up for all procedures was 22 months (range 0–55 months). Patency was defined as freedom from ≥50% restenosis or reocclusion.

Results

The technical success rate for all procedures was 93%. The 1-year cumulative primary patency rate based on intention to treat was 85%. Multivariate analysis revealed a significant independent association between patency rates and levels of fibrinogen and homocysteine and the nature of the lesion treated (stenosis vs. occlusion).

Conclusion

The aetiology of restenoses and reocclusions is probably multifactorial. Procoagulant activity, the nature of the lesion treated and homocysteine levels within and above the upper range of normal limits are important risk factors for failure after endovascular treatment of the common iliac arteries.

Keywords: Restenosis, Reocclusion, Homocysteine, D-Dimer, Fibrinogen, PTA, Common iliac arteries, Survival analysis