Atherosclerosis Of Lower Limb Arteries Research Articles

Different Statin Dosages and Their Effects on Osteoporosis

The aim of the study was to investigate the effect of different doses of statins on the progression of osteoporosis during a 36-month follow-up period. The study included 98 postmenopausal women diagnosed with osteoporosis and the presence of atherosclerosis of lower limb arteries. Patients were divided into 2 groups: women who received statins as part of atherosclerosis treatment (group 1, n=53) and those who did not receive statin therapy for hyperlipidemia (group 2, n=45). After 36 months of follow-up, patients were divided into two groups — with unfavorable (n=42) and favorable (n=56) course of osteoporosis. Progression of osteoporosis was considered unfavorable if during the follow-up period the patients had low traumatic fractures of large bones and/or progressive decrease in bone mineral density (BMD). Depending on the statin dose taken, patients were divided into groups: 1) those taking atorvastatin 20 mg or rosuvastatin 10 mg; 2) those taking atorvastatin 40 mg or rosuvastatin 20 mg. The results revealed a significant association between statin therapy and a favorable course of osteoporosis (OR=0.316, 95% C.I. =0.137-0.727, p=0.003). The use of higher doses of statins (atorvastatin 40 mg or rosuvastatin 20 mg) was associated with the development of low traumatic fractures of large bones and/or progressive decrease in MPC during 36 months of follow-up (OR=3.0, 95% C.I.=1.119-8.040, p=0.030). On the other hand, the use of lower doses of statins (20 mg atorvastatin or 10 mg rosuvastatin) was associated with a favorable course of osteoporosis (OR=0.047, 95% C.I.=0.010-0.212, p=0.030). The dose of statin taken was also moderately negatively correlated with IPC (r=−0.45; p=0.005). Thus, the use of statins for a long period (36 months) in low doses (atorvastatin 20 mg or rosuvastatin 10 mg) is an effective and safe method of treating cardiovascular comorbidities represented by atherosclerosis of lower limb vessels and osteoporosis in postmenopausal women and is characterized by a reduced risk of osteoporosis-related large bone fractures.

Translational Relevance of Advanced Age and Atherosclerosis in Preclinical Trials of Biotherapies for Peripheral Artery Disease.

Approximately 6% of adults worldwide suffer from peripheral artery disease (PAD), primarily caused by atherosclerosis of lower limb arteries. Despite optimal medical care and revascularization, many PAD patients remain symptomatic and progress to critical limb ischemia (CLI) and risk major amputation. Delivery of pro-angiogenic factors as proteins or DNA, stem, or progenitor cells confers vascular regeneration and functional recovery in animal models of CLI, but the effects are not well replicated in patients and no pro-angiogenic biopharmacological procedures are approved in the US, EU, or China. The reasons are unclear, but animal models that do not represent clinical PAD/CLI are implicated. Consequently, it is unclear whether the obstacles to clinical success lie in the toxic biochemical milieu of human CLI, or in procedures that were optimized on inappropriate models. The question is significant because the former case requires abandonment of current strategies, while the latter encourages continued optimization. These issues are discussed in the context of relevant preclinical and clinical data, and it is concluded that preclinical mouse models that include age and atherosclerosis as the only comorbidities that are consistently present and active in clinical trial patients are necessary to predict clinical success. Of the reviewed materials, no biopharmacological procedure that failed in clinical trials had been tested in animal models that included advanced age and atherosclerosis relevant to PAD/CLI.

Analysis of Influence of Cigarette Smoke on Signaling Pathways of Innate Immune System in Monocytes of Peripheral Blood

INTRODUCTION: Tobacco smoking is an important medical problem since it has a significant impact on the development and progression of chronic obstructive pulmonary disease (COPD). The components of tobacco smoke can initiate and support local and systemic inflammation with participation of monocytes and macrophages.
 AIM: To study molecular mechanisms associated with the impact of cigarette smoke on signaling pathways of the innate immune system in monocytes of peripheral blood.
 MATERIALS AND METHODS: The methods of in silico analysis was used to identify genes associated with the impact of tobacco smoke. On the basis of the data obtained, a cellular model of inflammation was created in vitro using tobacco smoke extract and monocytes of peripheral blood isolated by immunomagnetic separation. An enzyme-linked immunoassay (ELISA) kit was used to measure the concentration of tumor necrosis factor- (TNF-), interleukin-1 (IL-1) in cell supernatants, and of Toll-like receptor 4 (TLR4), ATP-binding cassette A1 (ABCA1) in homogenates of cell membranes of native monocytes and monocytes exposed to 4% tobacco smoke extract. These data were compared with the levels of TNF-, IL-1, TLR4 and ABCA1 in monocytes of peripheral blood of patients with COPD with frequent exacerbation phenotype and with obliterating atherosclerosis of lower limb arteries (OALLA). For statistical processing and visualization of the data, MedCalc 20.1.4 and R (version 4.2.2) software was used.
 RESULTS: Tobacco smoke influences TLR4, TNF- signaling pathways and lipid metabolism. Cigarette smoke extract enhanced the expression of proinflammatory cytokines TNF- and IL-1 in cell supernatants, increased the level of TLR4 and decreased that of ABCA1 in plasmolemma of monocytes of peripheral blood. In patients with COPD with frequent exacerbation phenotype and with OALLA, there were shown increase in the levels of proinflammatory TNF- and IL-1 cytokines in cell supernatants, increase in the level of TLR4 and reduction of the level of ABCA1 in plasmolemma of monocytes of peripheral blood compared to native monocytes of healthy individuals.
 CONCLUSION: Cigarette smoke enhances the production of proinflammatory TNF- and IL-1 cytokines, increases the levels of TLR4 protein and reduces the amount of ABCA1 transporter in membranes of monocytes of peripheral blood. This may partially explain the cause of the influence of cigarette smoke on development of the pulmonary and cardiovascular diseases. COPD with frequent exacerbation phenotype and OALLA are characterized by enhancement of inflammation with participation of monocytes.

Changes in oscillatory and nonlinear dynamic processes of microcirculation in patients with obliterating atherosclerosis of lower limb arteries after revascularization

Aim: To study the nature of changes in oscillatory and nonlinear dynamic processes in the skin microcirculatory system by laser Doppler flowmetry in patients with obliterating atherosclerosis of the lower limbs arteries (OALLA) after limb revascularization.Material and Methods. 27 male patients with OALLA before and after endovascular revascularization of the affected limb (median age 63.0 [60.0; 69.0] years) were studied. Microcirculation (MC) of the foot skin with assessment of nonlinear dynamic processes and spectral wavelet analysis of blood flow fluctuations was studied by laser Doppler flowmetry. The normalized amplitude indices of blood flow fluctuations were determined in frequency ranges reflecting: endothelial, neurogenic, myogenic, respiratory, pulse factors of hemocirculation. Bypass parameters and nutritive blood flow were assessed. An occlusion test was performed to determine capillary blood flow reserve. The study of nonlinear dynamic processes included assessment of fractal dimension, entropy determination and phase portrait analysis.Results. Limb revascularization in patients with OALLA resulted in improvement of the clinical picture accompanied by statistically significant increase in nutritive blood flow (+9.7%) and reserved dilatation potential of microvessels (+43.2%), decrease in arteriolo-venular blood shunting (–5.0%) and venous plethora (–14.3%). The analysis of nonlinear dynamic processes of the MC showed that after angioplasty, along with the remaining deficit of oscillatory processes energy, there was a decrease in the fractal dimension index (–14.3%), indicating the limitation of lability of the functional system of the microvascular bed. At the same time, an increase in the chaotization of the regulatory mechanisms of the peripheral blood flow was established.Conclusions. The results showed positive functional changes of the MC system associated with the improved clinical picture in patients with OALLA after limb revascularization. At the same time, changes in the nonlinear dynamics parameters indicate a compensatory increase in the chaotization of the system together with the remaining limitation of its functional lability and the energy deficit of oscillatory processes.

Клинический случай успешного лечения пациента с критической ишемией нижней конечности на фоне позднего дебюта антифосфолипидного синдрома

The antiphospholipid syndrome (APS) is characterized by non-inflammatory thrombotic vasculopathy with lesions of vessels of all types and localization. That is why clinical manifestations of APS are varied and patients turn to various physicians. The article describes a clinical case of a critical lower limb ischemia in AP. A 62 y. o. female patient was under outpatient observation for two years with the clinic of intermittent claudication and a diagnosis of atherosclerosis of lower limb arteries. At the same time, a history of thrombosis of the splenic artery — atypical for atherosclerosis, laboratory phenomena: a false-positive Wassermann reaction and an elongation of the phospholipid-dependent test (APTT) indicated APS. The patient was admitted into Department of Vascular Surgery of the Republic Clinical Hospital with critical lower limb ischemia and a threat of amputation. Antiphospholipid antibodies were detected. Due to the therapy pathogenetic for APS, amputation of the lower extremity was avoided. The presented clinical case shows that the APS may occur in people older than 60, and physicians of all specialties should be alert to this diagnosis.

Эффективность применения цилостазола у пациентов с перемежающейся хромотой

INTRODUCTION: Despite the intensive study of the pathophysiology, molecular and cellular mechanisms of atherosclerosis, the development and introduction of a number of new treatment methods, to date, the disease of the arteries of the lower extremities is one of the most pressing problems of modern vascular surgery and medicine in general. AIM: To evaluate the influence of cilostazol on the functional status of endothelium and pain-free walking distance in patients with lower limb artery diseases of atherosclerotic etiology. MATERIALS AND METHODS: The study was performed on 80 patients with obliterating atherosclerosis of lower limb arteries. Depending on the type of the given conservative therapy, the patients were divided to two groups. Group A (n = 40) included patients who received the baseline therapy in accordance with National recommendations on managing patients with peripheral artery diseases, and also medical drug Aducil® (cilostazol) 100 mg 1 tablet two times a day. Group В (n = 40) included patients who received only baseline therapy in accordance with National recommendations on managing patients with peripheral artery diseases. From all the patients, venous blood samples were taken for determining a number of markers of the endothelial dysfunction: endothelial nitric oxide synthase, prostacyclin, endothelin-1, interleukine-6. RESULTS: In 6 and 12 months after the start of the treatment, the level of endothelial nitric oxide synthase was reliably higher in group А patients (6 months — 12.91 (11.23–14.57) ng/ml; 12 months — 13.86 (12.42–16.25) ng/ml) in comparison with group В (6 months — 11.62 (8.63–16.73) ng/ml; 12 months — 11.76 (8.32–18.43) ng/ml) (р < 0.001). The level of prostacyclin was statistically significantly higher in group А after 6 months (group А — 18,532.88 (17,458.85–20,905.71) ng/ml; group В — 17,592.5 (15,542.56–19,721.52) ng/ml) and 12 months (group А — 18,452.27 (17,567.31–20,780.05) ng/ml; group В — 17,013.05 (15,090.1–19,517.58) ng/ml) in comparison with group В (р < 0.05). After 1 month from the start of treatment, the level of interleukin-6 was lower in group А (group А — 2.8 (2.23–3.4) ng/ml; group В — 3.65 (2.65–4.7) ng/ml), in 3 months — (group А — 2.4 (2–2.95) ng/ml; group В — 3.6 (2.55–4.5) ng/ml), 6 months (group А — 2.15 (1.73–2.88) ng/ml; group В — 3.45 (2.73–4.4) ng/ml), and 12 months (group А — 2.2 (1.93–2.95) ng/ml; group В — 3.3 (2.6–4.2) ng/ml) in comparison with group В (р < 0.001). No statistically significant difference in the levels of endothelin-1 was seen between group А and group В (p > 0.05). The analysis of the pain-free walking distance after 1 month (group А — 450 (436.25–487.5) m; group В — 250 (242.5–280) m), 3 months (group А — 455 (450–507.5) m; group В — 250 (250–277.5) m), 6 months (group А — 440 (430–487.5) m; group В — 235 (220–250) m), and 12 months (group А — 425 (410–465) m; group В — 210 (190–220) m) showed statistically reliable increase in the parameter in group А in comparison with group В (р < 0.001). Based on the results of USDS, the patients of group А showed statistically significant increase in the ankle-brachial index in 1, 3, 6 months (group А — 0.7 (0.7–0.7); group В — 0.6 (0.6–0.6)) and 12 months (group А — 0.7 (0.6–0.7); group В — 0.6 (0.5–0.6)) after the start of treatment in comparison with group В (р < 0.001). CONCLUSIONS: Treatment with cilostazol stimulates increase of the level of endothelial nitric oxide synthase and prostacyclin, and also promotes decrease in the level of interleukin-6. Cilostazol reliably increases pain-free walking distance and the ankle-brachial index.

Immunological and hemostasiological aspects of pathogenesis of obliterating atherosclerosis of arteries of the lower extremities

Objectives to study the changes in the immunological status and hemostatic system in patients with obliterating atherosclerosis of the lower limb arteries with the damage to the femoral-popliteal-tibial segment.
 Material and methods. A comprehensive study of the cytokine status and hemostatic system in patients with obliterating atherosclerosis of lower limb arteries with lesions of the femoral-popliteal tibia segment was carried out.
 Results. The progressive course of obliterating atherosclerosis is often associated with an increased content of cytokines (IL-1, IL-6, IL-8, TNF), as well as with the phenomena of hypercoagulation (increased platelet aggregation activity, shortened APTT, CT, TT, increased fibrinogen content), SFMCs, D-dimer).
 Conclusion. The study of the immunological status and hemostatic system should be performed in all patients with obliterating atherosclerosis of the lower limb arteries in order to adequately medically correct and prevent postoperative complications.

Genetic predictors of an unfavorable course of obliterating atherosclerosis of lower limb arteries

AIM: This study aimed to determine the influence of 250GA polymorphism in the LIPC gene and 1607insG in the MMP-1 gene on the course of obliterating atherosclerosis of lower limb arteries (OALLA).
 MATERIALS AND METHODS: Seventy-six individuals were included in this study. In the first group (n = 34), patients with an unfavorable (progressive) course of OALLA and developed critical ischemia of the lower limbs within 5 years from the onset of the disease were included. In the second group (n = 34), patients with a conventionally favorable (non-progressive) course but did not develop critical ischemia of the lower limbs within 5 years from the onset of the disease and did not have a progressive degree of chronic ischemia. In the control group, healthy volunteers (n = 8) without signs of atherosclerosis in all vascular pools were included. In all the patients, LIPC-250GA and MMP-1-1607insG were genotyped. The difference in the observed and expected frequencies was evaluated via a Pearson 2 test with correction for likelihood.
 RESULTS: Significant differences (p = 0.013) in the 250GA polymorphism of the LIPC gene were found between the observed and expected frequencies compared with those in patients with OALLA and healthy volunteers. The assessment of the first and second groups revealed differences in the observed and expected frequencies (р = 0.004). Heterozygous carriage (GA genotype) was associated with an increased risk of the development of the unfavorable course of OALLA (hazard ratio = 2.133 with 95% confidence interval = 1.2143.748). In the analysis of the 1607insG polymorphism of the MMP-1 gene, statistically insignificant data were obtained compared between the first and second groups (р = 0.128) and between the groups of patients with OALLA and healthy volunteers (р = 0.38).
 CONCLUSIONS: The heterozygous carrier of LIPC 250GA was associated with an increased risk of an unfavorable OALLA course. This research on this polymorphism could be applied to patients with the newly diagnosed atherosclerosis of the arteries of the lower extremities to determine the prognosis of the disease course, especially in young patients with early manifestation and individuals with a burdened hereditary history. The 1607insG polymorphism of the MMP-1 gene had no effect on the course of OALLA.

Субклинический атеросклероз сонных артерий и артерий нижних конечностей у пациентов 40–64 лет низкого и среднего кардиоваскулярного риска

Субклинический атеросклероз сонных артерий и артерий нижних конечностей у пациентов 40–64 лет низкого и среднего кардиоваскулярного риска

Markers of the course of obliterating atherosclerosis of lower limb arteries

The purpose of the study was to determine the level of substances damaging the vascular endothelium, as well as to assess their effect on the functional state of the endothelium and the course of obliterating atherosclerosis of lower limb arteries. The study included a total of 112 people, subdivided into three groups: those with an unfavourable course of obliterating atherosclerosis of lower limbs arteries (n=48) - group 1, patients with obliterating atherosclerosis of lower limbs arteries with a conventionally favourable course (n=48) - group 2, and apparently healthy volunteers (n=16). In all subjects, the following parameters were analysed: stable metabolites of nitric oxide II, endothelin-1, homocysteine and basal insulin. The level of stable nitric oxide metabolites (p<0.001 as compared with group 1; p<0.045 compared with group 2) was lower in the groups of patients with obliterating atherosclerosis of lower limb arteries (88.5±7.3 μmol/L in group 1; 161.5±8.6 μmol/L in group 2) as compared with healthy volunteers (226.0±28.6 μmol/L). In its turn, the level of nitric oxide was statistically significantly lower (p<0.001) in group 1 patients as compared with those of group 2. The level of endothelin-1 turned out to be higher (p<0.001) in group 1 (2.1±0.1 ng/ml) as compared with group 2 (1.6±0.1 ng/ml). Comparing group 1 patients with healthy volunteers (1.4±0.1 ng/ml), the level of endothelin-1 had also higher values (p<0.001). The level of endothelin-1 did not differ (p=0.270) as compared with group 2 and healthy volunteers. Comparing the homocysteine level in patients of the examined groups (20.7±0.8 μmol/L in group 1 patients and 18.1±0.6 μmol/L in group 2 patients) with healthy volunteers (13.0±0.4 μmol/L) demonstrated an increase in the parameters (p<0.001). The level of homocysteine turned out to be higher in group 1 patients than in those of group 2 (p<0.001). The level of basal insulin turned out to be significantly higher in the studied groups of patients with obliterating atherosclerosis of lower limb arteries (24.9±4.6 mIU/L in group 1; 8.0±0.7 mIU/L in group 2) than in healthy volunteers (5.1±0.5 mIU/L). Statistically significant (p<0.001) hyperinsulinemia was observed in group 1 as compared with group 2. Hyperhomocysteinemia and hyperinsulinemia are predictors of an unfavourable course of the disease. In a high level of these parameters, one may predict an unfavourable course of obliterating atherosclerosis of lower limb arteries.

Endothelial dysfunction in patients with obliterating atherosclerosis of lower limb arteries in systemic and local blood flow

Background and Aims: Objective: to assess the state of endothelial dysfunction in patients with obliterating atherosclerosis with occlusive-stenotic lesion of the femoral-popliteal arterial segment and features in the systemic and local blood flow.

The prognostic value of various markers of lower limb atherosclerotic lesions in patients with high and very high cardiovascular risk

Aim. To study the prognostic significance of various markers of atherosclerosis of lower limb arteries (LLA) in patients at high and very high cardiovascular risk (CVR).Methods. The study included 108 patients at high and very high CVR, the median age of which was 62.0 (55.7; 67.0) years. All patients underwent duplex scanning of the LLA, as well as measurement of the ankle-brachial index (ABI) by the Doppler method. The combined end point was cardiovascular death, nonfatal myocardial infarction or unstable angina, requiring hospitalization, nonfatal stroke, coronary revascularization.Results. Atherosclerotic plaques in LLA were detected in 69.4% of cases, while a decrease in ABI was detected in 22.2% of patients, and LLA stenosis more than 50% in 36.1%. The follow-up duration was 25.0 (14.5; 35.5) months. The adverse cardiovascular events occurred in 41 (37.9%) patients. According to the Cox regression results, the following indicators had an independent predictive value in relation to the development of adverse cardiovascular events: a decrease in ABI ≤0.9 (RR 2.23; 95% CI 1.01-4.94; p=0.048), LLA stenosis ≥40% (RR 3.17; 95% CI 1.27–7.92; p=0.013) and the presence of plaque in the popliteal arteries (RR 2.49; 95% CI 1.27–7.92; p=0.013).Conclusion. In the group of patients at high and very high CVR, among ultrasonographic markers of lower limb arteriosclerosis, independent predictive value regarding the development of adverse cardiovascular events had a decrease in ABI ≤0.9, the presence of plaque in the popliteal arteries and LLA stenosis more than 40%.

Factors and mechanisms of arterial hypertension development in patients with atherosclerosis of lower limb arteries

The article contains information about the frequency of development of arterial hypertension (AH), the features and causes of its development in patients with peripheral atherosclerosis. AH in patients with chronic atherosclerotic diseases of lower limb arteries and acute thrombotic occlusion complicates the course of this pathology. In most patients, the opinion that AH associated with atherosclerosis due to affection of renal arteries is generally accepted. Currently, an important practical question remains about the possible negative impact of intensive antihypertensive therapy with a significant reduction in blood pressure and aggravation of necrobiosis processes in the ischemic limb in a patient with acute arterial thrombosis.

Состояние макрогемодинамики и микроциркуляции у пациентов с окклюзионно-стенотическим поражением магистральных артерий нижних конечностей при различных типах реваскуляризующих вмешательств

Objective. The aim was to study the state of macrohemodynamics, microcirculatory bed and their relationship in patients with occlusive-stenotic lesions of the aorto-iliac-femoral arterial segment before and after revascularizing operations. Materials and methods. The results of the analysis of macrogemodynamic and microcirculatory bed state in 330 patients with obliterating atherosclerosis of lower limb arteries in various types of revascularizing interventions are presented: femoral-popliteal (group I, n=140), aorto-femoral (group II, n=97) bypass surgery, angioplasty with iliac artery stenting (group III, n=93). Results. There was a decrease in microcirculation in group I - 2.39 times, p<0.001, II - 3 times, p<0.001, III - 2.31 times, p<0.001, capillary blood flow reserve - in group I 1.63 times, p<0.001, II - 2.18 times, p<0.001, III - 1.77 times, p<0.001 and an increase in arterial-venular bypass regardless of the level of damage, as well as an oppression of endothelial mechanism and an increase in neurogenic mechanisms of regulation of microcirculation in all groups. Surgeries do not normalize microhemodynamics. Correlation interrelations of macrohemodynamics, changes in clinical status and microcirculation indices both in basal blood flow and under conditions of post-occlusive hyperemia were established. Changes in clinical status after surgery and bypass surgery had a negative-oriented correlation in all study groups (r=-0.2-0.3, p<0.05-0.01), and ankle-brachial index before and after surgery and RCC - the positive-oriented relationship (r=0.2-0.4, p<0.05-0.001). Conclusion. The state of microcirculation affects the change in clinical status after surgery, in this regard, it is necessary to take into account the parameters of microcirculation disorders and the mechanisms of regulation of tissue blood flow in surgical revascularization.

Molecular genetic aspects of early diagnosis and personalized treatment of obliterating atherosclerosis of lower limb arteries

Molecular genetic aspects of early diagnosis and personalized treatment of obliterating atherosclerosis of lower limb arteries

Combination of&#x0D; omega-3 polyunsaturated fatty acids and statins for the prevention of atrial fibrillation after coronary bypass surgery

Aim. To evaluate the influence of combination of omega-3 polyunsaturated fatty acids and atorvastatin on the risk of atrial fibrillation (AF) after coronary bypass surgery (CBS). Material and methods. The study included 114 patients divided into 2 groups, one comprised of 59 ones (75,6% men of mean age 62,0±7,3 yr given conventional medication), the other including 55 patients (80,0% men of mean age 59,4±6,7 yr given omega-3 polyunsaturated fatty acids 5 days before (2 g/d) and during 3 weeks after CBS (1 g/d)). All patients were treated with atorvastatin at the outpatient stage. IL-6,8, 10 and C-reactive protein (CRP), fibrinogen, troponin, NT-proBNP, superoxide dismutase (SOD), and myeloperoxidase were measured at admittance and on day 3.7±1.4 after surgery. Results. AF developed on day 5.9±4.9 (mean) after surgery. Patients of group 2 tended to have fewer new episodes of arrhythmia although no significant difference between the groups was documented (9,1% vs 18,6%, р=0,12). Group 2 included more smokers (74,5% vs 45,8%, р=0,002) and patients with atherosclerosis of lower limb arteries (87,3% vs 71,2%, р=0,03) but fewer those consuming nitrates (39,0% vs 18,2%, р=0,01) and Ca antagonists (45,8% vs 21,8%, р=0,006).Mean dose of atorvastatin given to patients of groups 1 and 2 was 24.7±12.5 and 25.1±10.5 mg/d respectively (р=0,2), duration of its intake 14.6±12.7 and 21.5±19.3 months (р&lt;0,001). There. was no significant difference between leukocyte count, leukogram, IL-8, IL-10, NT-proBNP, and troponin levels before and after CBS. Surgical myocardial revascularization caused a rise in leukocyte count, shifted the leukogram toward predominance of stab and segmented cells, increased IL-8, IL-10, fibrinogen, NT-proBNP, CRP, and troponin levels in both groups. IL-8 and IL-10 levels remained normal before and after surgery. Preoperative IL-6 level in group 1 was significantly higher than in group 2 (21,7±13,0 vs 2.5±2,2 pg/ml, р&lt;0,001). Postoperatively, the difference was absent. The CRP level before surgery was high in both groups (3122.7±2175.8 vs 3670.8±2490.0 U/g) but decreased after CBS although remained higher in group 1 (1957.6±1660.3 vs 1069.8±630.2 U/g, р&lt;0,001). Myeloperoxidase level increased postoperatively in both groups but the difference was insignificant. Fibrinogen and CRP in the postoperative period increased more significantly in group 2 than in group 1 (4,9±1,4 vs 4,4±1,1 g/l, р=0,02 and 8,6±2,2 vs 5,4±2,3 mg/l respectively, р&lt;0,001). Conclusion. The study revealed an insignificant decrease in the number of AF episodes in the early post-CDS period in patients treated with omega-3 polyunsaturated fatty acids and atorvastatin compared with those given the latter medication alone. Also, fibrinogen and CRP levels as markers of inflammation increased while SOD antioxidative activity decreased.

Polymorphism of the C-509 gene of TGFB1 and the risk of obliterative atherosclerosis of lower limb arteries

Genetic factors play an important role in the development of obliterative atherosclerosis of arteries in the lower extremities. There are numerous data in the literature on polymorphic variants of the TGFB1 gene associated with the risk of development of cardiovascular diseases, but some of them are contradictory. The present study aimed at elucidating the role ofpolymorphism of509C/T genes of TGFB1 in the development of obliterative atherosclerosis in arteries of the lower extremities. The material included 328 samples of DNA from 203 unrelated subjects of Russian ethnicity residing in Central Russia (177 men and 23 women) with obliterative atherosclerosis of arteries in the lower extremities hospitalized to the Dpt. of Vascular Surgery and 125 age-matched controls. Genotyping of polymorphism of the C-509T (rs1800469) gene of TGFB1 was performed by the PCR-PDRF method with the use of oligonucleotide primers (Sintol Co., Moscow). The patients with obliterative atherosclerosis showed an increased frequency of the occurrence of alternative allele of the C-509T gene of TGFB1 in comparison with control subjects (r=0,0001). Simultaneously, the frequency of homozygous genotypes of wild-type alleles of -509CC decreased (OR=0,58, 95%CI=0,37-0,92, P=0,02) while the frequency of homozygotes with an alternative allele -509TT increased (OR=4,93, 95%CI=5,20-11,03, P=0,00004). The difference in the frequency of heterozygotes 509CT was absent (OR=0,81, 95%CI=0,52-1,27, P=0,35). Thus, polymorphism of the C-509T gene of TGFB1 is a significant predictor ofpredisposition to the development of obliterative atherosclerosis in arteries of the lower extremities.

SURGICAL TREATMENT OF ATHEROSCLEROTIC LESION OF ILIAC ARTERIES BY METHOD OF LOOP ENDARTERECTOMY

Background: loop endarterectomy (LEA) is one of the low-traumatic methods of modern treatment of arteries of the lower extremities atherosclerosis. Objective: determining the advantages and disadvantages of loop endarterectomy of iliac arteries for successful implementation as a component of hybrid technology. Materials and methods: the study was carried the results of treatment of 131 patients with obliterating atherosclerosis of lower limb arteries, with a preferential defeat of the iliac arteries. All patients underwent unilateral or bilateral LEA. In the early and late (5-7 years) postoperative periods all the patients were studied using a questionnaire survey and ultrasonic angioscanning, 23 patients underwent aorto-angiography, 68 – MSCT-scan. Results: 107 (81,3%) cases the intervention was released only from the femoral access. Additional access to the retroperitoneal space required when performing a 24 (18,3%) operations. Specifi c to LEA complications was the casting areas of the plaque in the artery, other lower extremities, pronounced calcifi cation with lesion of all layers of the vascular wall hypoplasia, tortuosity or aneurysmal extension to the iliac arteries, high occlusion of the abdominal aorta. In these patients, shunting by synthetic prosthesis is the intervention of choice. In the early postoperative period occurred thrombosis 5 (3,8%), subjected to loop endarterectomy iliac arteries. Postoperative hospital day was 8+-2 days. Five-year survival after LEA is 77.1%. Conclusions: 1) the study showed that LEA is promising, and may be a priority intervention on the iliac arteries. 2) the remote results of patency of the iliac arteries after LEA signifi cantly higher than in synthetic grafts that are installed in the aorto-femoral position. 3) the rejection of the use of synthetic substitutes or their use to a minimum (only as a patch) signifi cantly reduces the risk of infectious complications.

FACTORS INFLUENCING ON THE MORTALITY IN PATIENTS WITH OBLITERATING DISEASES OF LOWER LIMB ARTERIES

Aim. To study the risk factors associated with the fatal outcome in patients with obliterating diseases of the lower extremities arteries at the stage of outpatient observation. Material and methods . The study included 467 patients (381 men and 86 women, the median age – 63 years [59;70]) with obliterating atherosclerosis of lower limb arteries >50%. Patients were examined in the framework of the current registry on the basis of the Kemerovo Cardiology Center for the period from 2009 to 2013. The examination included the dynamic observation of an angiosurgeon and a cardiologist, the determination of instrumental and laboratory indicators. During 3 years of follow-up, 42 deaths were registered (8.99% of the total number of patients), including 28 (65%) ones due to cardiovascular diseases. Patients were divided into two groups – with a fatal outcome (9%) and without it (91%). Results. The lethal outcome was associated with the male gender (83%), disability (69.8%), retirement status (85.5%), higher incidence of previously diagnosed myocardial infarction (38.5%), angina pectoris (66.6%), stroke or transient ischemic attack (19%). Lesions of two (86%) and three arterial basins (36%) and significant coronary bed lesions (74%) were more frequent in patients with lethal outcome, they were characterized by a longer smoking experience (17.9 years) and hypertension (14.5 years). Surviving patients were more likely to undergo reconstructive surgeries on lower limb arteries (26.5%). Conclusion. Factors associated with death in patients with obliterating diseases of the lower extremities arteries were angina pectoris [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.04-1.43; p=0.041), smoking experience (OR 1.28, 95% CI 1, 8-3,24; p=0,023), the duration of hypercholesterolemia (OR 2.01, 95% CI 0.35-4.12; p=0.012) and intermittent claudication (OR 2.01, 95% CI 0.35-4.12; p=0.041), presence of coronary artery stenosis ≥50% (OR 3.21, 95% CI 2.02-6.14; p=0.031), atherosclerosis of two or more arterial basins ≥50% (OR 3.43, 95% CI 3.46-5.52; p=0.004), the presence of a history of myocardial infarction (OR 2.12, 95% CI 0.75-6.02; p=0.043), and stroke (OR 2.23, 95% CI 2.05-4.21; p=0.021). To improve the effectiveness of secondary prevention in these patients it is advisable to use new organizational approaches at the outpatient stage of their management.

Indirect Revascularization of the Lower Limbs in Chronic Ischemia as an ALTERNATIVE ТО AMPUTATION

This article contains analysis of the results of examination of 46 patients with obliterating atherosclerosis of lower limb arteries isolated and combined with diabetes. There were determined ankle-brachial index, regional systolic pressure, volume flow rate, postocclusion venous pressure, intraosseous pressure in tibia and radionuclide investigation of blood flow in the lower limbs was carried. The indication for indirect revascularization of the lower limbs was developed based on the results of the investigation.