Selected endothelial hemostatic markers in patients with peripheral arterial disease after endovascular revascularization and restenosis formation

Abstract

Surgical and endovascular revascularization of ischemic legs in patients with peripheral arterial disease (PAD) can damage the arterial wall (endothelial and smooth muscle cells). Hemostatic factors released during endothelial dysfunction can lead to restenosis. 1. Determination of selected endothelial hemostatic factors in PAD patients and a reference group. 2. Prospective observation of new restenosis appearance in PAD patients after endovascular revascularization. 3. Comparison of selected endothelial hemostatic factors between non-restenotic and restenotic PAD patients. 150 PAD patients after endovascular revascularization - 90 men and 60 women, aged 44-88 (mean 65.5) years - were examined. During one-year observation after the revascularization procedures in 38 PAD patients restenosis occurred, when blood samples were also collected. The reference group consisted of 53 healthy persons - 44 men and 9 women, aged 20-56 years. Blood was drawn in the morning into 3.2% sodium citrate at a ratio of 9:1. Tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombomodulin (TM), von Willebrand factor (vWF) and tissue plasminogen activator (t-PA) were measured in plasma with commercial tests using the enzyme immunoassay. In the plasma of PAD patients after revascularization, the concentrations of TF and vWF were significantly higher, TM lower, TFPI and t-PA similar compared to the reference group. Six months after revascularization the level of TF had increased and vWF had significantly decreased. The endothelial hemostatic factors before and after restenosis did not significantly differ except TF, which after restenosis was higher. Increased TF and vWF levels in PAD patients indicate arterial endothelial cell damage, by atherosclerotic and revascularization processes. In PAD patients with restenosis compared to these patients before restenosis the determined endothelial hemostatic factors, except TF level, did not significantly differ. Perhaps TF participates in restenosis formation.

Tissue Factor and Other Hemostatic Parameters in Patients with Advanced Peripheral Artery Disease After Endovascular Revascularization – Search for Hemostatic Factors which Indicate Restenosis

“…Many articles exist on this theme. We also observed, in PAD patients after endovascular revascularization and in patients with restenosis increased inflammatory factors: CRP, fibrinogen and interleukin 6 and 10 [14]. The mean or median levels of TF, TAT complexes, fibrinogen and D-dimers in PAD patients after endovascular revascularization were significant higher than in the younger reference group (Table 2).…”

“…In our patients, higher fibrinogen level is not only a clotting factor, but also an inflammatory mediator. In group A of the patients, the mean level of CRP was 4.35 mg/L [14]. Schillinger et al suggested that CRP better predicts the inflammatory process than fibrinogen [18].…”

“…In these healthy persons, a medical history and physical examination as well as laboratory tests including blood type identification, blood cell count and viral test were performed. The reference group was younger than the PAD patients, but literature data suggests that sex and age do not influence the assessed parameters [7,14].…”

Detection of Endothelial Dysfunction Using Skin Temperature Oscillations Analysis During Local Heating in Patients With Peripheral Arterial Disease

“…Next finding of our study is that vasodilation indices (relative changes in temperature oscillations during local heating) in the endothelial range are well correlated with the laboratory markers of ED: endothelin, homocysteine, and vWF. Increased vWF levels in PAD patients indicate arterial endothelial cell damage by atherosclerotic and revascularization processes . We have found that, as the disease progresses, the levels of endothelin and vWF increase and are negatively correlated with the vasodilation index in the endothelial frequency range.…”

“…Some substances are considered potential laboratory markers of ED, such as tissue plasminogen activator and its inhibitor, thrombomodulin, homocysteine, vWF, and endothelin . Noninvasive explorations of cutaneous microcirculation based on the laser Doppler and temperature measurement techniques are widespread in the field of microvascular function research , but no studies have yet explored the relationship between multiple laboratory markers of ED and cutaneous blood flow parameters, particularly the characteristics of ST oscillations.…”