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

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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.

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About the authors

R Y Kalinin

Ryazan State Medical University

Email: kalinin-re@yandex.ru
ORCID iD: 0000-0002-0817-9573
Russian Federation, Ryazan, Russia

I A Suсhkov

Ryazan State Medical University

Email: suchkov_med@mail.ru
ORCID iD: 0000-0002-1292-5452
Russian Federation, Ryazan, Russia

E A Klimentova

Regional Clinical Hospital

Author for correspondence.
Email: klimentowa.emma@yandex.ru
ORCID iD: 0000-0003-4855-9068
Russian Federation, Ryazan, Russia

I N Shanaev

Regional Clinical Hospital

Email: c350@yandex.ru
ORCID iD: 0000-0002-8967-3978
Russian Federation, Ryazan, Russia

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Supplementary files

Supplementary Files
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1. Рис. 1. Дуплексная сканограмма области бифуркации общей бедренной артерии у здорового добровольца: 1 — общая бедренная артерия; 2 — поверхностная бедренная артерия; 3 — глубокая бедренная артерия (угол её отхождения 20°)

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2. Рис. 2. Дуплексная сканограмма области бифуркации общей бедренной артерии у пациента из группы В через 1 мес: 1 — общая бедренная артерия; 2 — синтетический протез; 3 — глубокая артерия бедра (угол её отхождения 60°)

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3. Рис. 3. Дуплексная сканограмма области бифуркации общей бедренной артерии у пациента из группы А через 1 мес: 1 — общая бедренная артерия; 2 — синтетический протез; 3 — глубокая артерия бедра (угол её отхождения 75°)

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4. Рис. 4. Сравнение динамики изменения концентрации маркёра sFas в послеоперационном периоде у пациентов исследуемых групп; *статистически значимое различие (р <0,05) между группами А и В

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5. Рис. 5. Сравнение динамики изменения концентрации тромбоцитарного фактора роста BB в послеоперационном периоде у пациентов исследуемых групп; *статистически значимое различие (р <0,05) между группами А и В

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