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Year 2018 Vol. 26 No 2

GENERAL & SPECIAL SURGERY

V.A. LAZARENKO, E.A. BOBROVSKAYA

HYPERHOMOCYSTEINEMIA AND FUNCTIONAL STATE OF ENDOTHELIUM IN PATIENTS WITH PERIPHERAL ARTERY DISEASE WITH ARTERIAL RECONSTRUCTIONS

Kursk State Medical University, Kursk,
The Russian Federation

Objective. To study the relationship between homocysteine and markers of the functional state of the endothelium in patients with obliterating atherosclerosis in operations on the aorta and arteries of the lower limbs.
Methods. The study included 68 patients with peripheral artery disease, the average age was 57.8±7.3 years, with II B – III degree of chronic arterial insufficiency according to R. Fontaine-A.V. Pokrovsky, who were divided into three groups: I group underwent the femoro-popliteal bypass (n=32), II – the aorto-femoral bypass (n=20), III – x-ray endovascular angioplasty and stenting of the iliac arteries (n=16). A correlation analysis was made between the content of homocysteine and the markers of the endothelium functional state of: the oxidized low-density lipoproteins (oxidized LDL), a molecule of adhesion of the vascular endothelium type 1 (sVCAM-1), the tissue type 1 plasminogen activator inhibitor (PAI-1), the tissue plasminogen activator (t-PA), Annexin V in the systemic and local bloodstream prior to surgery and after the arterial reconstructions.
Results. Correlation relationships between homocysteine and oxidized LDL were established both in the systemic blood flow and the affected limb, this association persisted after the reconstructive intervention, the most significant in the local bloodstream after femoro-popliteal bypass surgery. Preoperative positive correlation of the systemic level of homocysteine and sVCAM-1 in group I was marked. The effect of homocysteine on the fibrinolytic function of the endothelium was shown, as indicated by the direct correlation between homocysteine and PAI-1 in the systemic blood flow and in the affected limb, which persist after open reconstructions. Significant links between homocysteine and the level of Annexin V were revealed in the group of patients with the lesion of the femoro-popliteal arterial segment.
Conclusions. Hyperhomocysteinemia contributes significantly to the disturbance of the endothelium functional state, affecting apoptosis, the activation of atherogenic LDL, and the procoagulant potential, which persist even after arterial reconstructions both in the systemic and local bloodstream.

Keywords: peripheral artery disease, aorto-ileal segment, femoro-popliteal segment, reconstructive surgeries, X-ray endovascular interventions, homocysteine, endothelial dysfunction
p. 188-194 of the original issue
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Address for correspondence:
305041, The Russian Federation,
Kursk, K.Marx Str., 3,
Kursk State Medical University,
Department of Surgical Diseases
of the Faculty of Post-Graduate Training,
Tel.: +7 (4712) 58-81-32,
e-mail: azaroks@mail.ru,
Lazarenko Viktor A.
Information about the authors:
Lazarenko Viktor A., MD, Professor, Rector, Head of the Department of Surgical Diseases of the Faculty of Post-Graduate Training, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-2069-7701
Bobrovskaya Elena A., PhD, Associate Professor of the Department of Surgical Diseases of the Faculty of Post-Graduate Training, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-3898-5522
Contacts | ©Vitebsk State Medical University, 2007-2023