July 14, 2004

Comparative Analysis Of Autogenous Infrainguinal Bypass Grafts In African Americans and Caucasians: The Influence Of Race On Graft Function

David K Chew, Louis L Nguyen, Michael S Conte, Magruder C Donaldson, John A Mannick, Anthony D Whittemore, Edwin C Gravereaux, Mathew M Menard, Michael Belkin
Brigham and Women's Hospital, Boston, MA

Objective: African-Americans (AA) are at risk for developing diabetes mellitus and atherosclerosis. Whether race influences the results of infrainguinal arterial reconstruction is unclear. The purpose of this study was to compare the results of autogenous infrainguinal bypasses in AA and Caucasians to determine the impact of race on graft function.

Methods: Retrospective case-control study using data from a prospective vascular registry.

Results: From January 1985 to December 2003, 1899 autogenous infrainguinal bypasses were performed in 1479 patients for limb ischemia. Within this group, 89 AA patients/127 vein grafts formed the study cohort. The control group (110 Caucasian patients/127 vein grafts) were matched with the study cohort on gender (female 60%), diabetes (67%), indication (limb salvage 92%) and order of operation (primary 81%). Mean follow-up was: AA 31 mo, Caucasian 32 mo. Lost to follow-up was: AA 4% and Caucasian 9%. AA were significantly younger than Caucasians (mean age: 64 vs. 70 yr respectively, p < 0.001). Types of venous conduit were: greater saphenous vein GSV (AA 73%, Caucasian 74%), autogenous composite vein (AA 20%, Caucasian 18%), arm vein (AA 2%, Caucasian 8%). Site of distal anastomosis was at the tibial level in 74% AA and 70% Caucasian. Overall morbidity (AA 28%, Caucasian 23%) and 30-day mortality (AA 3%, Caucasian 2%) were similar. 30-day graft failure was significantly greater in AA than Caucasians (13% vs. 2% respectively, p < 0.002). Table shows the overall 5-year results. For GSV grafts, patency and limb salvage rates were significantly worse in AA compared to Caucasians. Diabetic AA had inferior limb salvage compared to diabetic Caucasians (64% + 7% vs. 91% + 3% respectively, p < 0.001).

Conclusions: The data suggests that lower limb ischemia occurs at an earlier age, and the results of infrainguinal arterial reconstruction are significantly worse in AA compared to Caucasians.