Autogenous Infrainguinal Bypass Outcomes Inferior in Hispanics.

Researchers from the Brigham and Women's Hospital and Harvard Medical School in Boston have released a 22-year study that reports Hispanic patients have poorer outcomes following infrainguinal bypass grafting for the treatment of peripheral arterial disease (PAD).

Results showed that of all the study participants, Hispanics had a higher rate of bypass graft failure and amputation after revascularization compared to Caucasians. In an analysis that accounted for a myriad of important variables affecting limb salvage after bypass, Hispanic ethnicity was found to be independently predictive of eventual amputation. Details of the study appear in the Society for Vascular Surgery's(R) June 2009 issue of the Journal of Vascular Surgery(R) (see also Heart Bypass Surgery).

"Despite our attempts to treat all patients very aggressively for severe lower extremity ischemia through revascularization to prevent amputation, limb preservation at five years was 80 percent in Hispanics, 84 percent in African-Americans, and a 91 percent in Caucasians," said Michael Belkin, MD, chief of the division of vascular and endovascular surgery.

Researchers said they embarked on this study when they noticed some of the Hospital's Hispanic patients seemed to demonstrate an aggressive form of PAD that was difficult to treat with infrainguinal bypass grafting, the "gold standard" for severe lower extremity ischemia. They also said there was very little information available about PAD in the Hispanic population and, in particular, little data on the outcomes of lower extremity bypass grafting in these patients.

Dr. Belkin explained that 1,646 consecutive patients who participated in the study (1,408 Caucasians, 57 Hispanics and 181 African-Americans) underwent autogenous infrainguinal reconstructions. He added Hispanic patients, like African-Americans counterparts, often required a bypass at younger age and more commonly had diabetes in comparison to Caucasians. African-Americans and Hispanics also had severe atherosclerosis below the level of knee and therefore required bypass operations lower down the leg, which are more technically demanding.

In comparison to Caucasians, "Hispanics required additional interventional procedures or operations to maintain adequate blood flow through these grafts," said Dr. Belkin. "From our analysis of factors which contribute to graft failure, it appears that a preponderance of young patients and females, both known risk factors for graft failure, in our Hispanic population may have contributed to the initial graft failures in these patients."

In addition to Hispanic ethnicity, independent ...