Effect of occult malignancy on femoropopliteal bypass graft thrombosis

C Y Maximilian Png; Linda J Wang; Charles S DeCarlo; Christopher A Latz; Brandon J Sumpio; Ido Weinberg; Matthew J Eagleton; Anahita Dua

doi:10.1016/j.jvs.2021.01.058

Effect of occult malignancy on femoropopliteal bypass graft thrombosis

J Vasc Surg. 2021 Aug;74(2):514-520.e2. doi: 10.1016/j.jvs.2021.01.058. Epub 2021 Feb 16.

Authors

C Y Maximilian Png¹, Linda J Wang², Charles S DeCarlo², Christopher A Latz², Brandon J Sumpio², Ido Weinberg³, Matthew J Eagleton², Anahita Dua²

Affiliations

¹ Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: cypng@mgh.harvard.edu.
² Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
³ Institute for Heart Vascular and Stroke Care, Massachusetts General Hospital, Boston, Mass.

PMID: 33600933
DOI: 10.1016/j.jvs.2021.01.058

Abstract

Objective: The presence of cancer increases arterial thromboembolic events, specifically myocardial infarction and stroke, before a formal diagnosis of cancer. To the best of our knowledge, this increase in thrombotic risk has not been studied in patients with lower extremity bypass grafts. In the present study, we aimed to determine the effect of occult cancer on femoropopliteal bypass patency.

Methods: A retrospective review of femoropopliteal bypass procedures completed from 2001 to 2018 was performed. International Classification of Diseases, 9th and 10th revision, codes corresponding to breast, lung, prostate, colorectal, skin, brain, and hematologic cancer were used to identify patients who had had occult cancer. Occult cancer was defined as cancer diagnosed within ≤1 year after the bypass procedure. The demographics, comorbidities, bypass configuration and conduit, 1-month, 3-month, 6-month, and 1-year occlusion rates, major adverse limb events, and mortality rates were analyzed. Statistical analysis included t tests, χ² tests, and Cox regression analysis.

Results: A total of 621 procedures in 517 patients met the inclusion criteria. Of the 621 procedures, 36 (5.8%) were classified as procedures in patients with occult cancer. The patients with occult cancer had had higher occlusion rates at 3 months (27.8% vs 8.0%; P < .001), 6 months (30.5% vs 15.1%; P < .01), and 1 year (44.4% vs 19.8%; P < .001). In Cox regression analysis for bypass thrombosis at 1 year, the only significant predictors were occult cancer (hazard ratio [HR], 2.03; P = .01), below-the-knee distal target (HR, 1.88; P < .01), and a compromised conduit (HR, 2.14; P < .001).

Conclusions: We found an increase in bypass graft thrombosis rates in patients who had undergone femoropopliteal bypass who had had occult cancer. Thrombosis of the graft within 1 year postoperatively might be a sign of occult cancer.

Keywords: Bypass; Cancer; Lower extremity bypass; Malignancy; Occlusion; Occult; Patency; Thrombosis.

MeSH terms

Aged
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects*
Blood Vessel Prosthesis Implantation / instrumentation
Blood Vessel Prosthesis Implantation / mortality
Female
Graft Occlusion, Vascular / diagnostic imaging
Graft Occlusion, Vascular / etiology*
Graft Occlusion, Vascular / mortality
Humans
Male
Neoplasms / complications*
Neoplasms / diagnosis
Neoplasms / mortality
Peripheral Arterial Disease / complications
Peripheral Arterial Disease / diagnostic imaging
Peripheral Arterial Disease / mortality
Peripheral Arterial Disease / surgery*
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Thrombosis / diagnostic imaging
Thrombosis / etiology*
Thrombosis / mortality
Time Factors
Treatment Outcome