The effect of the geometry of the proximal anastomosis, markers of apoptosis and cell proliferation on the long-term patency following reconstructive interventions on the femoropopliteal arterial segment

Abstract

Aim. To study changes in the topography of the orifice of the deep femoral artery (DFA), markers of proliferation, and apoptosis in patients after open interventions on the femoropopliteal arterial segment.

Methods. The study included 35 patients with atherosclerotic peripheral arterial disease (PAD), femoral-popliteal occlusion, stage IIB–III of the disease according to the classification of A.V. Pokrovsky–Fontaine, who underwent open surgery. The average age of the patients was 69±4.6 years. These patients included 26 men. Patients were divided into two groups: group A included 18 patients who underwent femoral-popliteal prosthetics (distal End-To-End bypass anastomoses), group B included 17 patients with femoral-popliteal bypass surgery (distal End-To-Side bypass anastomoses). The groups were comparable in terms of age and disease severity (p >0.05). Determination of serum platelet-derived growth factor BB (PDGF BB) and soluble form Fas (sFas) levels was carried out immediately before the intervention, on the 1st, 7th days, and 1 month after the operation. Duplex scanning (DS) was performed on day 7, after 1 and 18 months. Statistica 10.0 software was used for statistical data processing. The significance of differences between unrelated samples was assessed using the Student's t-test. The correlations between variables were analyzed by using Pearson's method.

Results. On 1st day, there was a decrease in soluble Fas in patients of group A compared with group B (0.41 ng/ml vs 0.78 ng/ml, p=0.01). On the 7th day, the levels of serum platelet-derived growth factor BB were increased in patients of group A compared with group B (35.2 ng/ml vs 23.2 ng/ml, p=0.00001). After 1 month, the level of serum platelet-derived growth factor BB in patients of group A remained elevated compared with those in patients of group B (22.8 ng/ml vs 14.4 ng/ml, p=0.0003).

Conclusion. Femoropopliteal prosthetics leads to a change in branching angle of the deep femoral artery up to 70–80%, accompanied by changing dynamics of apoptotic markers and cell proliferation, leading to an increase in the thickness of neointimal hyperplasia and the progression of atherosclerosis.

Keywords

atherosclerosis / sFas / PDGF BB / deep femoral artery / bifurcation angle / intimal hyperplasia / restenosis

References

[1] Shabani Varaki E., Gargiulo G.D., Penkala S., Breen P.P. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed. Eng. Online. 2018; 17 (1): 61. DOI: 10.1186/s12938-018-0494-4.

[2] Yudin V.A., Vinogradov S.A., Krylov A.A., Gerasimov A.A. Аutovenous revascularization of the lower extremity arteries in patients with variant anatomy of the peripheral blood flow and the progressive atherosclerotic process. Probl. Sotsialnoi Gig. Zdravookhranenniia i Istor. Med. 2019; 27 (6): 1093–1097. DOI: 10.32687/0869-866X-2019-27-6-1093-1097.

[3] Ascher E. Haimovici's vascular surgery. Blackwell, Massachustts, USA. 2004; 1221 p. Russ ed.: Ascher E. Sosudistaya hirurgiyapo Hajmovichu. Vol. 2. M.: Binom. Laboratoriya znanij. 2010; 536 p. (In Russ.)

[4] Ашер Э. Сосудистая хирургия по Хаймовичу. Т. 2. М.: Бином. Лаборатория знаний. 2010; 536 с.

[5] Sapelkin S.V., Kuznetsov M.R., Kalashnikov V.Yu., Ostroumova O.D., Galstyan G.R., Chupin A.V., Chernyavskiy M.A. Proekt natsional'nykh rekomendatsiy po diagnostike i lecheniyu zabolevaniyu arteriy nizhnikh konechnostey. (National guidelines for the diagnosis and treatment of lower limb artery disease.) M.: Rossijskij soglasitel'nyj dokument. 2018; 111 p. (In Russ.)

[6] Cапелкин С.В., Кузнецов М.Р., Калашников В.Ю., Остроумова О.Д., Галстян Г.Р., Чупин А.В., Чернявский М.А. Проект национальных рекомендаций по диагностике и лечению заболеванию артерий нижних конечностей. M.: Российский согласительный документ. 2018; 111 с.

[7] Cronenwett J.L., Johnston K.W. Rutherford’s vascular surgery. 8th ed. Elsevier. 2014; 2784 p.

[8] Amiri M.H., Keshavarzi A., Karimipour A., Bahiraei M., Goodarzi M., Esfahani J.A. A 3-D numerical simulation of non-Newtonian blood flow through femoral artery bifurcation with a moderate arteriosclerosis: investigating Newtonian/non-Newtonian flow and its effects on elastic vessel walls. Heat Mass. Transf. 2019; 55 (7): 2037–2047. DOI: 10.1007/s00231-019-02583-4.

[9] Fitzgerald T.N., Shepherd B.R., Asada H. Laminar shear stress stimulates vascular smooth muscle cell apoptosis via the Akt pathway. J. Cell. Physiol. 2008; 216 (2): 389–395. DOI: 10.1002/jcp.21404.

[10] Gosgnach W., Messika-Zeitoun D., Gonzalez W., Philipe M., Michel J.B. Shear stress induces iNOS expression in cultured smooth muscle cells: Role of oxidative stress. Am. J. Physiol. Cell. Physiol. 2000; 279 (6): 1880–1888.

[11] Kalinin R.E., Suchkov I.A., Klimentova E.A., Egorov A.A., Povarov V.O. Apoptosis in vascular pathology: present and future. I.P. Pavlov Russian Medical Biological He¬rald. 2020; 28 (1): 79–87. (In Russ.) DOI: 10.23888/PAVLOVJ202028179-87.

[12] Калинин Р.Е., Сучков И.А., Климентова Э.А., Егоров А.А., Поваров В.О. Апоптоз в сосудистой патологии: настоящее и будущее. Рос. мед.-биол. вестн. им. акад. И.П. Павлова. 2020; 28 (1): 79–87. DOI: 10.23888/PAVLOVJ202028179-87.

[13] Klimentova E.A., Suchkov I.A., Egorov A.A., Kalinin R.E. Apoptosis and cell proliferation markers in inflammatory-fibroproliferative diseases of the vessel wall (review). Sovremennye tekhnologii v me¬ditsine. 2020; 12 (4): 119–128. (In Russ.) DOI: 10.17691/stm2020.12.4.13.

[14] Климентова Э.А., Сучков И.А., Егоров А.А., Калинин Р.Е. Маркёры апоптоза и пролиферации клеток при воспалительно-фибропролиферативных заболеваниях сосудистой стенки (обзор). Соврем. технол. в мед. 2020; 12 (4): 119–128. DOI: 10.17691/stm2020.12.4.13.

[15] Haga M., Yamashita A., Paszkowiak J., Sumpio B.E., Dardik A. Oscillatory shear stress increases smooth muscle cell proliferation and Akt phosphorylation. J. Vasc. Surg. 2003; 37 (6): 1277–1284. DOI: 10.1016/s0741-5214(03)00329-x.

[16] Papadopoulos N., Lennartsson J. The PDGF/PDGFR pathway as a drug target. Mol. Aspects Med. 2018; 62: 75–88. DOI: 10.1016/j.mam.2017.11.007.

[17] Kalinin R.E., Abalenikhina Yu.V., Pshennikov A.S., Suchkov I.A., Isakov S.A. Interrelation between oxidative carbonylation of proteins and lysosomal proteolysis of plasma in experimentally modelled ischemia and ischemia-reperfusion. Nauka molodykh (Eruditio Juvenium). 2017; (3): 338–351. (In Russ). DOI: 10.23888/ HMJ20173338-351.

[18] Калинин Р.Е., Абаленихина Ю.В., Пшенников А.С., Сучков И.А., Исаков С.А. Взаимосвязь окислительного карбонилирования белков и лизосомального протеолиза плазмы в условиях экспериментального моделирования ишемии и ишемии-реперфузии. Наука молодых (Eruditio Juvenium). 2017; (3): 338–351. DOI: 10.23888/ HMJ20173338-351.

[19] Spanos K., Petrocheilou G., Karathanos C., Labropoulos N., Mikhailidis D., Giannoukas A. Carotid bifurcation geometry and atherosclerosis. Angiology. 2017; 68 (9): 757–764. DOI: 10.1177/0003319716678741.

[20] Apenberg S., Freyberg M.A., Friedl P. Shear stress induces apoptosis in vascular smooth muscle cells via an autocrine Fas/FasL pathway. Biochem. Biophys. Res. Commun. 2003; 310 (2): 355–359. DOI: 10.1016/j.bbrc.2003.09.025.

RIGHTS & PERMISSIONS

Eco-Vector