Cardiovascular Surgery
doi: 10.25005/2074-0581-2023-25-4-478-487
FUNCTIONAL ACTIVITY OF ENDOTHELIUM IN THE SYSTEMIC AND LOCAL BLOOD FLOW IN PATIENTS WITH OBLITERATING ATHEROSCLEROSIS AND RESTENOSIS AFTER FEMOROPOPLITEAL BYPASS SURGERY

V.A. LAZARENKO1, E.A. BOBROVSKAYA1, V.A. LIPATOV2, I.S. IVANOV3

1Department of Surgical Diseases of the Institute of Continuing Education, Kursk State Medical University, Kursk, Russian Federation
2Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation
3Department of Surgical Diseases № 1, Kursk State Medical University, Kursk, Russian Federation

Objective: To analyze the role of markers of the endothelial dysfunction in the vessels of the systemic and local blood flow before and after femoropopliteal bypass surgery (FPBS) in the development of restenosis at obliterating lesions of the femoropopliteal arterial segment (FPAS).

Methods: The results of the examination and treatment of 82 patients with obliterating atherosclerosis who underwent FPBS were analyzed. Before and after surgery they underwent testing for serum homocysteine, oxidized low-density lipoprotein, soluble vascular cell adhesion molecule-1 (sVCAM-1), plasminogen activator inhibitor-1 (PAI-1), tissue-type plasminogen activator (t-PA), and annexin V in the systemic and local blood flow. Based on the condition of the reconstruction zone after 12 months, all patients were divided into two groups. Group 1 included patients without restenosis (n=21), and Group 2 – with restenosis (n=61).

Results: Before surgery Group 2 patients showed significant differences in the severity of adhesive and hemostatic forms of endothelial dysfunction, as well as apoptosis in comparison with Group 1. It was found that before surgery, Group 2 patients had a significantly higher level of sVCAM-1 in the local bloodstream (by 37.5%, p=0.014), PAI-1 in the systemic and local bloodstream (by 15.6%, p=0.010, and by 16.4%, p=0.008 respectively) and annexin V in the systemic and local bloodstream (by 48.9%, p=0.012 and by 60.2%, p=0.002 respectively). After surgery Group 2 patients had significantly higher levels of PAI-1 in the systemic (by 18.9%, p=0.004) and local (by 11.1%, p=0.049) blood flow, and annexin V in the systemic circulation (by 28.4%, p=0.011) compared with Group 1. Thus increased levels of sVCAM-1 in the local bloodstream, PAI-1, and annexin V – in the systemic and local bloodstream before surgery were associated with postoperative development of restenosis, while higher values of PAI-1 in the systemic and local bloodstream and annexin V in the systemic circulation after surgery were related to subsequent restenosis development.

Conclusion: The results of the study indicate impairment of the adhesive and hemostatic function of the endothelium, and increased level of apoptosis in the blood vessels of systemic and local blood flow in patients with restenosis, which can be used to develop personalized approach to management of this disorder and improve the results of revascularization interventions on FPAS.

Keywords: Obliterating atherosclerosis of the lower extremities, femoropopliteal bypass surgery, functional activity of the endothelium, restenosis.

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Authors' information:

Lazarenko Viktor Anatolyevich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Surgical Diseases of the Institute of Continuing Education, Rector of Kursk State Medical University
Researcher ID: G-8460-2013
Scopus ID: 7003836715
ORCID ID: 0000-0002-2069-7701
SPIN: 9751-0688
Author ID: 364370
E-mail: azaroks@mail.ru

Bobrovskaya Elena Anatolyevna,
Doctor of Medical Sciences, Associate Professor, Professor of the Department of Surgical Diseases of the Institute of Continuing Education of Kursk State Medical University
Researcher ID: HSG-1347-2023
Scopus ID: 57201668227
ORCID ID: 0000-0003-3898-5522
SPIN: 9497-7358
Author ID: 276102
E-mail: ea-bobrovskaya@yandex.ru

Lipatov Vyacheslav Aleksandrovich,
Doctor of Medical Sciences, Full Professor, Vice-Rector for Research and Innovative Development, Professor of the Department of Operative Surgery and Topographic Anatomy, Head of the Laboratory of Experimental Surgery and Oncology of the Research Institute of Experimental Medicine of Kursk State Medical University
Researcher ID: D-8788-2013
Scopus ID: 6603948707
ORCID ID: 0000-0001-6121-7412
SPIN: 1170-1189
Author ID: 197586
E-mail: drli@yandex.ru

Ivanov Ilya Sergeevich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Surgical Diseases № 1, Kursk State Medical University
Researcher ID: Y-6224-2019
Scopus ID: 12770405200
ORCID ID: 0000-0003-4408-961Х
SPIN: 3122-8015
Author ID:217585
E-mail: ivanov.is@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Bobrovskaya Elena Anatolyevna
Doctor of Medical Sciences, Associate Professor, Professor of the Department of Surgical Diseases of the Institute of Continuing Education of Kursk State Medical University

305041, Russian Federation, Kursk, Karl Marx street, 3

Tel.: +7 (910) 3194810

E-mail: ea-bobrovskaya@yandex.ru

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