Hyperhomocysteinaemia is a risk factor for vein graft stenosis

Many infrainguinal vein graft failures are due to progressive vein graft stenosis (VGS) from intimal hyperplasia. Systemic factors have been implicated in the aetiology of intimal hyperplasia. Hyperhomocysteinaemia (HHCA) is established as an independent risk factor for coronary and peripheral arterial disease. The objective of this study was to examine the influence of HHCA and other serological factors upon the development of VGS. Thirty-eight patients who had undergone infrainguinal vein bypass were recruited to a case/control study from a graft surveillance program. Nineteen patients with documented VGS were matched against controls without stenosis for age, sex, length of time from surgery, diabetes, smoking history and preoperative symptom score. All patients were recalled for Duplex ultrasound scans, venesection and carbon monoxide estimation which were performed in a blinded fashion. Statistical analysis of all parameters revealed that plasma homocysteine was significantly elevated in patients with VGS (p < 0.3, Wilcoxon rank sum). These results suggest that HHCA is a previously unidentified risk factor for VGS. Patients with HHCA are susceptible to VGS and preoperative investigation would allow identification of patients at risk.