Morphological changes in the distal segments of the aorta femoral reconstructions as predictors of late thrombosis

Abstract

Results of studying the effect of histological type of atherosclerotic plaques in the area of vascular anastomoses after reconstructive operations on the main arteries of the lower extremities on the risk of developing late thrombotic complications are presented. It was found that atherosclerotic plaques in patients with no evidence of a hemodynamically significant restenosis in the distal anastomosis identified thickening and overgrowth of fibrous connective tissue, the amount of lipids is minimal or absent, stored elastic fibers and the layers of smooth muscle cells. The extracellular lipids in extensive, but well-defined area in the intima. Macrophages are single and located mainly along the periphery of the lipid core, form clusters of 2–3 cells, there are no lipid inclusions in the cytoplasm. In atherosclerotic plaques of patients with late thrombosis in the distal anastomosis area, a significant uneven thickening and proliferation of fibrous connective tissue was revealed, lipid inclusions are represented by a large nucleus or a group of nuclei. Elastic fibers are replaced by collagen fibers and inclusion of lipids, several sites of calcification are noted. Macrophages form association of 4-5 cells at the periphery of the lipid core and in the coating, where their number is significantly higher; in their cytoplasm the inclusion of lipids are noted. Generally, it was revealed that the histological characteristic of atherosclerotic plaques of VI, VII type (AHA 5 classification [6]) correlated with the high risk of late thrombotic complications in patients operated with peripheral artery disease.

Keywords

peripheral artery disease / reconstructive surgery / restenosis / thrombosis / histology / histological study of atherosclerotic plaques / risk of late thrombotic complications

References

[1] Бокерия, Л.А. Отчет о состоянии сердечно-сосудистой хирургии в РФ за 2012 г. / Л.А. Бокерия, Б.Г. Алекян // М.– 2013. – 73 с.

[2] Лазаренко, В.А. Морфологические причины стенотических реокклюзий при артериальных реконструкциях аорты и магистральных артерий нижних конечностей / В.А. Лазаренко [и др.] // Курский научно-практический вестник «Человек и его здоровье». – 2008. – № 4. – С. 61–66.

[3] Покровский, А.В. Состояние сосудистой хирургии в 2014 г. / А.В. Покровский, В.Н. Гонтаренко. – М.: Институт хирургии им. А.В. Вишневского. – 2015. – 99 c.

[4] Шатравка, А.В. Анализ ранних и поздних послеоперационных осложнений после реконструктивных операций на артериях аорто-бедренного сегмента: дис. … канд. мед. наук / А.В. Шатравка. – СПб., 2008. – 186 с.

[5] Швальб, П.Г. Сравнение отдалённых результатов реконструктивных операций у больных облитерирующим атеросклерозом артерий нижних конечностей / П.Г. Швальб, Р.Е. Калинин, Ю.В. Алфёров // Ангиология и сосудистая хирургия. – 2008. – т. 15, № 2. – С. 362–363.

[6] ACC/AHA 2005 Practice Guidelines for the management of patients arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation / A.T. Hirsch [et al.] // Circulation. – 2006. – Vol.113, № 11. – Р. 463–654.

[7] Egorova, N.N. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety / N.N. Egorova [et. al.] // J. Vasc. Surg. – 2010. – Vol. 51, № 4. – Р. 878–885.

[8] Gwan-Chul, L. Ten year outcomes after bypass surgery in aortoiliac occlusive disease / L. Gwan-Chul [et. al.] //J. Korean. Surg. Soc. – 2012. – № 82 (6). – P. 365–369.

[9] Libby, P. Inflammation in atherosclerosis, from pathophysiology to practice / P. Libby [et. al.] // J. Am. Coll. Cardiol. – 2009. – №54. – P. 2129–2138.

[10] Stary, H.C. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis / H.C. Stary [et al.] // American Heart Association. Circulation. – 1995. – 92. – P. 1355–1374.

[11] Wang-Soo, L. Progression and Observational Frequency of Atheromatous Plaques in Autopsied Coronary Arteries / L. Wang-Soo // Korean Circulation Journal. – 2009. – 39 (10).– P. 399–407.