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Abstract:

Aim: was to assess dynamics of markers of endothelial dysfunction after open reconstructive and endovascular operations on the aortoiliac segment.

Material and methods: the study included 36 patients, who were divided into two groups depending on the method of performed operations. Patients of the first group (n = 20) underwent open surgery - aortofemoral bypass, the second group (n = 16) underwent endovascular stenting and angioplasty of iliac arteries. We examined the level of the endothelial dysfunction markers: homocysteine, oxidized low density lipoprotein, adhesion molecules of vascular endothelium type 1 (sVCAM-1) Annexin V the inhibitor (PAI-1) and tissue plasminogen activator (t-PA) in the systemic circulation and in operated limb before the operation and in the early postoperative period.

Results: an expression of endothelial dysfunction after reconstructive surgery on the aortoiliac segment was established in both, systemic and local blood flow. Carrying of X-ray-endovascular operations was accompanied by endothelial dysfunction, which was comparable with open repair. Increased concentration of sVCAM-1 after surgery was revealed in all groups with greater dynamics in the operated limb. Annexin V content in the local blood flow in patients of the second group is significantly lower than of the first (at 42,66%, p <0.05).The most significant changes were found in the fibrinolytic activity in the performance of X-ray-endovascular interventions. A significant increase in systemic and local concentrations of PAI-1 was marked in the second group. The level of PAI-1 in the operated limb after stenting was 1,93 times higher than that in an open procedure. In contrast, post-operative changes in t-PA in patients undergoing endovascular surgery, showed an increase in t-PA compared to open surgery group.

Conclusion: in the complex examination of patients with atherosclerosis obliterans before anc after reconstructive surgery is necessary to monitor markers of endothelial dysfunction with the aim of personalized correction.

 

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