Atherosclerosis Of Lower Extremity Arteries Research Articles

Аналіз коморбідних станів пацієнтів високого ризику з ускладненими формами ішемічної хвороби серця перед кардіохірургічним втручанням

Aim: To analyze comorbidity in high-risk patients with complicated forms of coronary artery disease before cardiac surgery. Materials and methods: Retrospective analysis of 160 randomly selected high-risk patients with complicated coronary artery disease who underwent open-heart surgery and were discharged from the Institute in the period from 2009 to 2019. The average age of patients was 59.06±9.8 years. All the patients underwent routine clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography and cardiac surgery. Before cardiac surgery was performed risk stratification of patients on EuroSCORE II scale, according to the calculation, the severity of patients averaged 10.08%, which indicates a high risk of surgical death. The severity on the EuroSCORE II scale for patients with postinfarction left ventricular aneurysms was in average 9.9%, in patients with ischemic mitral regurgitation - 12.4%, and among patients with a combination of coronary artery disease with aortic valve disease, the risk of surgical death was in average 9, 2%. Results: When analyzing the baseline status of 160 high-risk patients with complicated forms of coronary artery disease, it was found that the average body mass index of patients was 28.9±4.04 kg/m2 [range 20.76-40.5 kg/m2], the level of glucose on admission was in average 6.8±2.6 mmol/l [range 3.4-21.6 mmol/l], serum creatinine averaged 107.2±25.2 μmol/l [range 56-207 μmol/l], and the estimated glomerular filtration rate averaged 67.9±18.03 ml/min/1.73 m2 [range 28-120 ml/min/1.73 m2]. Thus, 68 (42.5%) patients were overweight, 60 (37.5%) had obesity I-III st., 40 (25%) - type 2 diabetes mellitus, 79 (49.3%) - impaired glucose tolerance. 57 (35.6%) patients had chronic kidney disease with glomerular filtration rate <60 ml / min / 1.73 m2. Atherosclerotic stenosis of the carotid arteries >50% was diagnosed on Doppler study of brachiocephalic arteries in 35 (21.8%) patients. Varicose veins of the lower extremities C4-C6 stages had 42 (26.2%) patients. For 124 (77.5%) patients atherosclerosis of lower extremities arteries of different stages. Chronic obstructive pulmonary disease had 130 (81.2%) patients. 122 (76,2%) patients had a bad habit in the form of smoking, among which 20 (12.5%) continued smoking during hospitalization. 10 (6.25%) patients had gouty arthritis. Despite a high predicted mortality of 10.08% on the EuroSCORE II scale, all patients were discharged after successful surgery. Conclusions: Management of cardiac surgery patients with high-risk coronary artery disease in the perioperative period has its own characteristics and requires a personalized approach, taking into account not only cardiac features, but also comorbidity that have a great prognostic value

Growth Factor Deregulation and Emerging Role of Phosphatases in Diabetic Peripheral Artery Disease.

Peripheral artery disease is caused by atherosclerosis of lower extremity arteries leading to the loss of blood perfusion and subsequent critical ischemia. The presence of diabetes mellitus is an important risk factor that greatly increases the incidence, the progression and the severity of the disease. In addition to accelerated disease progression, diabetic patients are also more susceptible to develop serious impairment of their walking abilities through an increased risk of lower limb amputation. Hyperglycemia is known to alter the physiological development of collateral arteries in response to ischemia. Deregulation in the production of several critical pro-angiogenic factors has been reported in diabetes along with vascular cell unresponsiveness in initiating angiogenic processes. Among the multiple molecular mechanisms involved in the angiogenic response, protein tyrosine phosphatases are potent regulators by dephosphorylating pro-angiogenic tyrosine kinase receptors. However, evidence has indicated that diabetes-induced deregulation of phosphatases contributes to the progression of several micro and macrovascular complications. This review provides an overview of growth factor alterations in the context of diabetes and peripheral artery disease, as well as a description of the role of phosphatases in the regulation of angiogenic pathways followed by an analysis of the effects of hyperglycemia on the modulation of protein tyrosine phosphatase expression and activity. Knowledge of the role of phosphatases in diabetic peripheral artery disease will help the development of future therapeutics to locally regulate phosphatases and improve angiogenesis.

Nephrogenic factors in development of arterial hypertension among patients with atherosclerosis of lower extremity arteries with complications of acute thrombotic occlusion

Research aim . The article is devoted to the research of the mechanisms of arterial hypertension development among patients with abdominal aortic atherosclerosis and formation of chronic lower limb ischemia (Leriche’s syndrome). Materials and methods . The presence of thrombotic occlusion of the extremity arteries and its level were evaluated in 129 cases of atherosclerotic aortic lesion complicated by acute thrombotic occlusion of the lower (112) and upper (17) extremities, according to physical data the absence of pulsation (or a sharp decrease in it) on the arteries during palpation, according to the results of ultrasound Doppler scanning of the limb arteries and according to multispiral computer angiography with contrasting. Uzdg was performed on a multi-functional ultrasound scanner MyLab 70 (Esaote, Italy), in in-mode. Echocardiography was performed on Acuson 128XP device (Acuson, USA) in two-dimensional and M-modal modes. Left ventricular systolic function was evaluated in B-mode using the Simpson method (1995). The glomerular filtration rate was calculated using the Cockcroft-Gault formula. The coagulogram was studied on the device ACL Elite Top (USA). Results . With the development of thrombotic occlusion of the lower extremity arteries, the character of the course of arterial hypertension worsens. Chronic arterial hypertension is detected in most patients with aortic atherosclerosis, complicated by thrombotic occlusion of the lower and upper limb arteries. More than 80 % of hypertension is characterized by systolic-diastolic type and only a small part (less than 20 %) shows isolated systolic character. Conclusions . Operative restoration of the main blood flow in the extremities has a positive effect on the course of hypertension in most patients.

Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease.

Peripheral artery disease (PAD) stems from atherosclerosis of lower extremity arteries with resultant arterial narrowing or occlusion. The most severe form of PAD is termed chronic limb-threatening ischemia and carries a significant risk of limb loss and cardiovascular mortality. Diabetes mellitus is known to increase the incidence of PAD, accelerate disease progression, and increase disease severity. Patients with concomitant diabetes mellitus and PAD are at high risk for major complications, such as amputation. Despite a decrease in the overall number of amputations performed annually in the United States, amputation rates among those with both diabetes mellitus and PAD have remained stable or even increased in high-risk subgroups. Within this cohort, there is significant regional, racial/ethnic, and socioeconomic variation in amputation risk. Specifically, residents of rural areas, African-American and Native American patients, and those of low socioeconomic status carry the highest risk of amputation. The burden of amputation is severe, with 5-year mortality rates exceeding those of many malignancies. Furthermore, caring for patients with PAD and diabetes mellitus imposes a significant cost to the healthcare system-estimated to range from $84 billion to $380 billion annually. Efforts to improve the quality of care for those with PAD and diabetes mellitus must focus on the subgroups at high risk for amputation and the disparities they face in the receipt of both preventive and interventional cardiovascular care. Better understanding of these social, economic, and structural barriers will prove to be crucial for cardiovascular physicians striving to better care for patients facing this challenging combination of chronic diseases.

Skin microhemodynamics in patients with obliterating atherosclerosis of lower extremities arteries and diabetes mellitus type 2

Introduction. Chronic tissue ischemia appeared due to obliterating atherosclerosis of lower extremities arteries (OALEA) enhances diabetic microangiopathy making prognosis worse. Due to fundamental biological importance of microcirculation (MC), the study of tissue blood flow in case of this pathology receives huge theoretical value.Purpose of the study was to reveal features of skin MC in patients with diabetes mellitus type II (DM) with OALEA in comparison with the same group of patients without DM.Material and methods. The study involved 111 males with claudication IIB stage and ancle-brachial index (ABI) ≤0.85, which were randomized into two groups equal in age and main clinical and anamnesis data (Gr.1 –without DM (n=77) and Gr.2 – with DM (n=34)). Skin MC was examined using Laser Doppler Flowmetry.Results. Patients with DM had statistically important lowering of blood flow oscillatory amplitude in myogenic (34,5 %) and endothelial (27,8 %) frequency ranges in comparison with the alternative group. Together with the growth of myogenic tone (63,5 [38,6; 123,4] vs 43,6 [28,9; 75,0] u), it reflects depression of vasolytic features and constriction of precapillary segment of the bloodstream. The study revealed significant limitation (18,9 %) of nutritional blood flow and increase of the intensity of arterial and venous bypass grafting in patients of Gr.2 (2,6 [1,8; 4,0 vs 2,0 [1,2; 3,0] u) in Gr. 1.Conclusion. The studied patients had monotype MC alterations. However, they are more pronounced in patients with DM; it worsens the disease prognosis.

Complication during Endovascular Intervention: Acute Ischemia of the Lower Extremity as a Result of Spiral Dissection with Antegrade Puncture of the Left Common Femoral Artery

Introduction. Over the past decade, endovascular interventions have become widely used in patients with obliterating atherosclerosis of lower extremity arteries. This is due to the low-trauma nature of the methodology, various technological achievements in the improvement of instruments and the accumulation of operational experience. However, despite all the successes achieved, no intervention is without its complications. In the case of endovascular interventions, complications are most commonly associated with the site of arterial access. One of the most widely-used arterial approaches is retrograde femoral access. However, if an intervention is planned on the femoropopliteal arterial segment, the antegrade femoral approach is generally the method of choice. Among the advantages of antegrade access can be noted the shorter path to the site, better toolkit support and a shorter operation duration. One of the main complications involved in antegrade access is the development of dissection. Although this complication occurs in less than 1% of cases, it carries a threat of critical ischemia of the lower limbs, which may require emergency open surgery up to and including emergency limb amputation.Materials and methods. The paper presents a clinical case of successful treatment of iatrogenic spiral dissection, which occurred following antegrade vascular access. During surgical treatment of this complication, stents were implanted throughout the dissection to “press” the exfoliated layer of the intima.Results. The study presents a case of iatrogenic spiral dissection after antegrade femoral puncture followed by successful endovascular treatment of this complication.Conclusion. Endovascular balloon angioplasty and stenting can be successfully used when iatrogenic dissection develops following antegrade puncture of the right femoral artery, allowing classic “open” surgical intervention to be avoided.

Functionality of skin microhemocirculation in patients with obliterating atherosclerosis of lower extremity arteries as per laser Doppler flowmetry

Introduction. High prevalence and a poor prognosis of obliterating atherosclerosis of lower extremity arteries make the comprehensive study of the disease as a pressing issue. Aim of the study. To reveal features of functional state of lower extremities skin microcirculation (MC) in patients with intermittent claudication (IC). Material and methods. Microcirculation in 75 patients with IC and 15 healthy subjects was assessed by laser Doppler flowmetry. Results. In IC patients compared to healthy people significant decrease in nutritive blood flow by 25.9 % was detected as well as activation of arterio-venous blood shunting (+45.6 %) with venous congestion that causes worsening in blood rheology abnormalities. Conclusion. The detected shifts in MC lead to the progression of functional insufficiency in peripheral blood flow.

GENDER DIFFERENCE AND COMORBIDITIES IN CHRONIC HEART FAILURE PATIENTS

Aim. Investigation and analysis of clinical-hemodynamic signs of chronic heart failure (CHF) at the age 42-89 y. o., including the assessment of gender and comorbidities, according to ejection fraction (EF) of the left ventricle (LV): preserved EF LV ≥45% (HFpEF) and low EF LV <45% (HFrEF). Material and methods. Totally, 120 CHF patients studied, age 42-89 y. o., with assessment of gender and comorbidities, accoring to ejection fraction (EF) of the left ventricle (LV): preserved EF LV ≥45% (HFpEF) and low EF LV <45% (HFrEF). Results. In most cases the etiology of CHF was coronary heart disease (CHF) — 58,8%, and in 68,3% cases it was comorbid with arterial hypertension (AH). Assessment of CHF in patients with various EF LV showed that in both groups males predominated. In HFrEF there were more overweight patients (41,1%) and in HFpEF — obesity patients (51,6%). In HFrEF patients main factors leading to myocardial impairment were myocardial infarctions in anamnesis (91,1%), and in HFpEF — CHD with AH (81,3%), obesity (51,6%) and diabetes (43,8%). Extracardiac comorbidity in HFrEF was mostly chronic obstructive pulmonary (26,8%) and obliterate atherosclerosis of lower extremities arteries (17,9%), and HFpEF — congestion pneumonia (23,4%) and varicose vein disease (34,4%). Conclusion. Patients with HFrEF — are mostly the CHD patients having risk factors: smoking, alcohol overconsumption, excessive physical exertion. HFpEF patients are mostly CHD+AH, most of them had metabolic disorders. Most cases of varicose vein disease and pneumonia in HFrEF can be explained by obesity and increased rate of diabetes. Cases of vascular dementia in HFpEF patients are related to higher prevalence of AH and its complications.

COMORBIDITIES IN PATIENTS WITH CORONARY ARTERY DISEASE ADMITTED TO CARDIAC SURGERY CENTERS IN CHELYABINSK AND KEMEROVO

Aims . To estimate the detection rate of comorbidities in patients admitted for surgical treatment of coronary artery disease (CAD) and to compare surgical treatment options in two cardiac surgery centers. Methods . All the patients older 18 years who underwent coronary artery bypass grafting in 2014 (isolated or combined coronary artery bypass grafting and heart valve repair or replacement and/or aneurysmectomy) admitted to the Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo (Kemerovo group; n =1166) and in the Federal Center for Cardiovascular Surgery, Chelyabinsk (Chelyabinsk group; n = 1293) were included in the study. Results. The mean age of patients in the Kemerovo group was 62.5±7.8 years, and in the Chelyabinsk group 61.3±7.8 years (p &lt;0.0001). There were significant differences in the incidence rate of postinfarction cardiosclerosis between Kemerovo and Chelyabinsk (66.7% vs. 85.6%, p&lt;0.0001). Patients in the Kemerovo group commonly had obstructive pulmonary disease (13.9 vs 6.2%, p&lt;0.0001), previous acute cerebrovascular accident (7.1 vs 4.6%, p&lt;0.007), atherosclerosis oflower extremity arteries (10.7 vs 3.2%, p&lt;0.0001), gastroduodenal ulcer (15.3 vs 11.0%, p&lt;0.002) compared to patients in the Chelyabinsk group. On average, there are 0.6±0.02 of the above mentioned dis eases per one patient in Kemerovo and0.4±0.01 in Chelyabinsk (p&lt;0.0001). Patients in the Kemerovo group commonly underwent stenting of coronary arteries (13.0 vs 9.9%, p&lt;0.014) compared to patients in the Chelyabinsk group. Each fourth patient underwent combined CABG and the other surgeries in Chelyabinsk, whereas in Kemerovo each sixth patient receivedcombined surgical treatment(p&lt;0.0001). The number of combined CABG and left ventricular reconstruction was comparable in both centers. The linear regression analysis reported that the du-ration of surgery and cardiopulmonary bypass time are statistically significantly associated with the performance of combined surgeries (p&lt;0.0001), the presence of comorbidities (p&lt;0.0001) and patient age (p&lt;0.05). Conclusion. Patients in the Kemerovo group commonly suffered from concomitant coronary artery disease, whereas patients in theChelyabinsk group were present with postinfarction cardiosclerosis. Each fourth patient underwent combined surgery in Chelyabinsk, whereas in Kemerovo each sixth patient received combined surgical treatment. The number of combined CABG and left ventricular reconstruction was comparable in both centers.

Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes.

Peripheral artery disease (PAD) is the atherosclerosis of lower extremity arteries and is also associated with atherothrombosis of other vascular beds, including the cardiovascular and cerebrovascular systems. The presence of diabetes mellitus greatly increases the risk of PAD, as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status compared to patients without diabetes. To minimize these cardiovascular risks it is critical to understand the pathophysiology of atherosclerosis in diabetic patients. This, in turn, can offer insights into the therapeutic avenues available for these patients. This article provides an overview of the epidemiology of PAD in diabetic patients, followed by an analysis of the mechanisms by which altered metabolism in diabetes promotes atherosclerosis and plaque instability. Outcomes of PAD in diabetic patients are also discussed, with a focus on diabetic ulcers and critical limb ischemia.

The combination of revasculizative (остеотрепанации) with other operative interference of patients with obliterating atherosclerosis of arteries of lower extremity

The main problem at reconstructive interference in vessels of patients with obliterating atherosclerosis of lower extremity arteries (OAALE) is the restriction of outflow because of many level involvements. The revasculizative (остеотрепанация) of a shin is the alternative of amputation of the extremity. We suggest to have the combinations of revasculizative (остеотрепанации) of a shin with reconstructive operations on arteries of lower extremities and also in combination with lumber sympathicomy and roentgenoendovascular dilatations. (RED).