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The effects of normalising hyperhomocysteinemia on clinical and operative outcomes in patients with critical limb ischaemia.
Peadar Waters, MB BCh MRCS, Paul Fennesy, MB BCh, Niamh Hynes, MB BCh MRCS MMSc MD, Sherif Sultan, MD FRCS FACS.
Western Vascular Institute, Galway, Ireland.

Objectives: The aim of this study was to assess the outcome of patients with treated hyperhomocysteinemia (HyhC) requiring intervention for Chronic Limb Ischaemia (CLI).
Design: Original article: Comparative Parallel Observational Group Study
Methods and Materials: In this prospective study we analysed the effect of normalizing HyhC in pre-operative patients with CLI between 2009-2011 (n=66, Group A). Data was collated from our prospectively updated patient database and composite endpoints were compared to 103 patients with normal homocysteine. Group A were then compared to a group of HyhC patients from pre-treatment hyperhomocysteinemia era of 2002-2006 which were previously studied (Group B). All interventions were performed by the same surgeon. Both groups were evenly matched.
Results: The median age was 73 years and median Homocysteine level was 11 (Range 5 - 34.9). In Group A, Immediate clinical improvement was equivalent to the normal homocysteine group. There was no significant difference in time to binary restenosis in between both groups, p=0.8517. Secondary endpoints and all cause survival showed no significant difference. Pre-Treatment Multivariate Logistic Regression for group B; depicts HyhC as significant in Graft occlusion and limb loss p<0.0001. Multivariate Logistic Regression for all group reports that medically corrected HyhC is no longer a significant factor of operative outcome.
Conclusion: We conclude that patients with medically corrected HyhC, using folic acid and vitamin B12 have similar outcomes compared to those with normal homocysteine.


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