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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References
  1. Pokrovskiy AV, Golovyuk AL. Sostoyanie sosudistoy khirurgii v Rossiyskoy Federatsii v 2018 g [The state of vascular surgery in the Russian Federation in 2018]. Angiologiya i sosudistaya khirurgiya. 2019;25(2):2-46.
  2. Vassalli G, Klersy C, De Servi S, Galatius S, Erne P, Eberli F, et al; BASKET-PROVE Investigators. Can the optimal type of stent be predicted based on clinical risk factors? A subgroup analysis of the randomized BASKET-PROVE trial. Am Heart J. 2016;173:1-7. https://doi.org/10.1016/j.ahj.2015.11.007
  3. Sazhinov AP, Lukinskiy AV, Chupin AV. Puti uluchsheniya prokhodimosti bedrenno-podkolenno-bertsovykh shuntov [Ways to improve patency of femoral-popliteal-tibial shunts]. Angiologiya i sosudistaya khirurgiya. 2014;20(1):141-5.
  4. Svetlikov AV, Ishpulaeva LE. Sovremennaya strategiya uluchsheniya otdalyonnykh rezul’tatov khirurgicheskogo lecheniya zabolevaniy perifericheskikh arteriy [A modern strategy for improving long-term results of surgical treatment of peripheral artery diseases]. Angiologiya i sosudistaya khirurgiya. 2020;26(4):23-30.
  5. Burkov NN, Zhuravlyova IY, Barbarash LS. Prognozirovanie riska razvitiya trombozov i stenozov bioprotezov «Kemangioprotez» putyom postroeniya matematicheskoy modeli [Prediction of thrombotic and stenotic complications after «Kemangioprotez» biological prosthesis implantation by means of mathematical model]. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2013;4:5-11. https://doi.org/10.17802/2306-1278-2013-4-5-11
  6. Wanschel ACBA, Guizoni DM, Lorza-Gil E, Salerno AG, Paiva AA, Dorighello GG, et al. The presence of cholesteryl ester transfer protein (CETP) in endothelial cells generates vascular oxidative stress and endothelial dysfunction. Biomolecules. 2021;11(1):69. https://doi.org/10.3390/biom11010069
  7. Matsuzawa Y, Kwon TG, Lennon RJ, Lerman LO, Lerman A. Prognostic value of flow-mediated vasodilation in brachial artery and fingertip artery for cardiovascular events: A systematic review and meta-analysis. J Am Heart Assoc. 2015;4(11):e002270. https://doi.org/10.1161/JAHA.115.002270
  8. Chia PY, Teo A, Yeo TW. Overview of the assessment of endothelial function in humans. Front Med (Lausanne). 2020;7:542567. https://doi.org/10.3389/ fmed.2020.542567
  9. Gimbrone MA Jr, García-Cardeña G. Endothelial cell dysfunction and the pathobiology of atherosclerosis. Circ Res. 2016;118(4):620-36. https://doi. org/10.1161/CIRCRESAHA.115.306301
  10. Widmer RJ, Lerman A. Endothelial dysfunction and cardiovascular disease. Glob Cardiol Sci Pract. 2014;3:291-308. https://doi.org/10.5339/gcsp.2014.43
  11. Vasina LV, Petrishchev NN, Vlasov TD. Endotelial’naya disfunktsiya i eyo osnovnye markyory [Markers of endothelial dysfunction]. Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya. 2017;16(1):4-15. https://doi. org/10.24884/1682-6655-2017-16-1-4-15
  12. Vlasov TD, Nesterovich II, Shimanskiy DA. Endotelial’naya disfunktsiya: ot chastnogo k obshchemu. Vozvrat k «staroy paradigme»? [Endothelial dysfunction: From the particular to the general. Return to the «old paradigm»?] Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya. 2019;18(2):19-27. https:// doi.org/10.24884/1682-6655-2019-18-2-19-27
  13. Tatsumi K, Mackman N. Tissue factor and atherothrombosis. J AtherosclerThromb. 2015;22(6):543-9. https://doi.org/10.5551/jat.30940
  14. Kalinin RE, Suchkov IA, Mzhavanadze ND, Zhurina ON, Klimentova EA, Povarov VO. Coagulation factor activity and hemostatic markers of endothelial dysfunction in patients with peripheral arterial disease. Vasc Specialist Int. 2021;37:26. https://doi.org/10.5758/vsi.210010.
  15. Small AM, Huffman JE, Klarin D, Sabater-Lleal M, Lynch JA, Assimes TL, et al; Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Hemostasis Working Group and the VA Million Veteran Program. Mendelian randomization analysis of hemostatic factors and their contribution to peripheral artery disease – brief report. Arterioscler Thromb Vasc Biol. 2021;41(1):380-6. https://doi.org/10.1161/ATVBAHA.119.313847
  16. Kalinin RE, Suchkov IA, Mzhavanadze ND, Klimentova EA, Zhurina ON, Isakov SA. Intrinsic coagulation cascade factors and hemostatic markers of endothelial dysfunction in patients with peripheral artery disease. Novosti khirurgii. 2018;26(5):547-54. https://doi.org/10.18484/2305-0047.2018.5.547
  17. Hiatt WR, Armstrong EJ, Larson CJ, Brass EP. Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease. Circ Res. 2015;116:1527-39. https://doi.org/10.1161/CIRCRESAHA.116.303566
  18. Kryukov EV, Shakhnovich PG, Tagirova GK, Kazakov SP, Shibina LV. Poisk sovremennykh laboratorno-diagnosticheskikh prediktorov effektivnosti chreskozhnogo koronarnogo vmeshatel’stva u bol’nykh s ishemicheskoy bolezn’yu serdtsa [Search for modern laboratory diagnostic predictors of the effectiveness of percutaneous coronary intervention in patients with coronary artery disease]. Kardiologicheskiy vestnik. 2020;S:55-6.
  19. Parshakov AA, Zubareva NA, Mizeva IA, Podtaev SYu. Sostoyanie mikrotsirkulyatsii i biokhimicheskie markyory endotelial’noy disfunktsii posle medikamentoznogo lecheniya i khirurgicheskoy korrektsii krovotoka u bol’nykh s aterosklerozom sosudov nizhnikh konechnostey [Microcirculation and biochemical markers of endothelial dysfunction after medical and surgical treatment in patients with peripheral arterial disease]. Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya. 2020;19(1):35-46. https://doi.org/10.24884/1682-6655- 2020-19-1-35-46
  20. Kuznetsov MR, Khaitov MR, Turkin PYu, Moskalenko EP, Pinegin BV. Rol’ narusheniy gumoral’nogo i kletochnogo immuniteta v geneze stenoza sosudistykh anastomozov posle rekonstruktivnykh vmeshatel’stv na arteriyakh taza i nizhnikh konechnostey [The role of disorders of humoral and cellular immunity in the genesis of vascular anastomosis stenosis after reconstructive interventions on the arteries of the pelvis and lower extremities]. Grudnaya i serdechno-sosudistaya khirurgiya. 2005;2:29-33.
  21. Natsional’nye rekomendatsii po diagnostike i lecheniyu zabolevaniy arteriy nizhnikh konechnostey [National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities]. Moscow, RF: 2019. 89 p.
  22. Lazarenko VA, Bobrovskaya EA. Gipergomotsisteinemiya i funktsional’noe sostoyanie endoteliya u patsientov s obliteriruyushchim aterosklerozom nizhnikh konechnostey pri arterial’nykh rekonstruktsiyakh [Hyperhomocysteinemia and functional state of endothelium in patients with peripheral artery disease with arterial reconstructions]. Novosti khirurgii. 2018;26(2):188-94. https://doi.org/10.18484/2305-0047.2018.2.188
  23. Tishko VV, Shperling MI, Fyodorov AS, Proskunov DI, Abolmasov DV, Lutsyk KM, et al. Rol’ molekul kletochnoy adgezii i antiproliferativnogo pokrytiya v razvitii restenoza koronarnogo stenta [The role of cell adhesion molecules and antiproliferative coating in the coronary stent restenosis]. Ateroskleroz i dislipidemii. 2021;1:30-41. https://doi.org/10.34687/2219-8202.JAD.2021.01.0003
  24. Yu J, Liu Y, Peng W, Xu Z. Serum VCAM-1 and ICAM-1 measurement assists for MACE risk estimation in ST-segment elevation myocardial infarction patients. J Clin Lab Anal. 2022;36(10):e24685. https://doi.org/10.1002/jcla.24685
  25. Yau JW, Teoh H, Verma S. Endothelial cell control of thrombosis. BMC Cardiovasc Disord. 2015;15:130. https://doi.org/10.1186/s12872-015-0124-z
  26. Kotschy D, Kotschy M, Socha P, Masłowski L, Kwapisz J, Żuk N, et al. Selected endothelial hemostatic markers in patients with peripheral arterial disease after endovascular revascularization and restenosis formation. Polish Postepy Hig Med Dosw. 2015;69:905-12. https://doi.org/10.5604/17322693.1164409

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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