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Blood Protein Predictors of Lower Extremity Vein Bypass Graft Failure and Remodeling

Open AccessPublished:June 10, 2022DOI:https://doi.org/10.1016/j.jvssci.2022.05.032

      Background

      Blood proteins may regulate the remodeling process of vein grafts (VGs) used to bypass occlusive lower extremity arteries. This study assessed the associations between blood protein levels and later VG remodeling and patency.

      Methods

      A prospective study was performed on 37 males undergoing autogenous VG placement. Computed tomography scans were performed at postoperative 1 week, 1 month, and 6 months to obtain VG lumen cross-sectional areas (CSA) and quantify VG remodeling at 1-mm intervals. Computational fluid dynamics simulations provided wall shear stress (WSS) and oscillatory shear index (OSI) data. Correlations between CSA changes in a period and the WSS or OSI at the beginning of the period were assessed for each VG, considering spatial autocorrelation between slices of the same VG. 28 plasma proteins were measured using the Luminex xMAP platform or an analyzer (C-reactive protein [CRP]) preoperatively, and 2 hours, 1 day, 1 week, and 1 month postoperatively.

      Results

      Six VGs failed within 1 year after implantation. The level of eotaxin (P = .026), interleukin (IL)-2 (P = .009), or CD40L (P = .031) at 1 week and CRP (P = .032), IL-2 (P = .047), sE-selectin (P = .037), or Soluble intercellular adhesion molecule-1 (P = .047) at 1 month were significantly associated with VG failure within 1 year. Preoperative IL-6 level was associated with binary lumen CSA increase or decrease from 1 week to 1 month (P = .041). A higher postoperative 2 hour IL-1b (P = .013) or 1 day IP10 (P = .027) level was associated with a weaker positive correlation between 1 week and 1 month VG remodeling and WSS at 1 week. A higher postoperative 1 week CRP level was associated with a stronger negative correlation between 1 week and 1 month VG remodeling and OSI at 1 week (P = .048). A higher preoperative IP10 (P = .030) or E-selectin (P = .017), or 2 hour E-selectin (P = .006), or 1 day E-selectin (P = .013) level was associated with a weaker positive correlation between 1 month and 6 months VG remodeling and WSS at 1 month. A higher postoperative 1 day CRP (P = .004) or IL-17 (P = .042), or 1 month IL-3 (P = .049) or IL-7 (P = .022) level was associated with a stronger negative correlation between 1 month and 6 months VG remodeling and OSI at 1 month.

      Conclusions

      Levels of early inflammatory blood proteins after VG implantation are predictive of VG failure within 1 year. A higher inflammatory blood protein level may predict a subsequent weaker positive association between VG remodeling and initial WSS or a subsequent stronger negative association between VG remodeling and initial OSI within 6 months of VG implantation.