Immune status in developing restenosis in patients with occlusive-stenotic lesion of the femoral-popliteal arterial segment after femoral-popliteal bypass surgery

Objective: to assess the immune status of systemic and local blood flow after femoral-popliteal bypass surgery in patients with and without restenosis. Materials and methods. The analysis of the treatment of 82 patients who underwent femoral-popliteal bypass surgery was carried out. Depending on the condition of the reconstruction zone after 12 months, the patients were divided into two groups: group I - 21 patients without restenosis, group II - 61 patients with the development of restenosis. The analysis of IgA, IgM, IgG, circulating immune complexes (CIC), interleukin (IL)-6, IL-1 in the systemic and local blood flow before and after surgery was performed. Results. In patients with the development of restenosis of the reconstruction zone, the level of IgA in the systemic and IgA, IgM in the local bloodstream was initially lower, the level of CIC, IL-1, IL-6 in the systemic and IgG, IL-1, IL-6 in the local bloodstream was higher, after surgery, the level of IgA in the local bloodstream was lower, higher - IgM in systemic and IL-6 in local blood flow in comparison with patients without restenosis. The correlation between the immune status and the development of restenosis was established: before surgery in the systemic circulation - IgA (r=-0.31, p<0.01), CIC (r=0.39, p<0.001), IL-6 (r=0.25, p<0.05), IL-1 (r=0.26, p<0.05), in the local bloodstream - IgA (r=-0.26, p<0.05), IgM (r=-0.30, p<0.01), IgG (r=0.26, p<0.05), IL-6 (r=0.30, p<0.01), IL-1 (r=0.29, p<0.01); after surgery in the systemic circulation - IgM (r=0.33, p<0.01), in the local - IgA (r=-0.24, p<0.05), IL-6 (r=0.40, p<0.001). The relationship between the degree of chronic arterial insufficiency (r=0.22, p<0.05), the ankle- brachial index after surgery (r=-0.27, p<0.05) with the development of restenosis was revealed. Conclusion. The interrelation of the immune status of the systemic and local blood flow before and after surgery and restenosis in the anastomosis zone after femur-popliteal bypass surgery has been shown. The study of the immune status will make it possible to develop an algorithm for restenosis prevention.

1. Boland J., Long C. Update on the Inflammatory Hypothesis of Coronary Artery Disease. Curr Cardiol Rep. 2021;23(2):6. DOI: 10.1007/s11886-020-01439-2.

2. Zernecke A., Winkels H., Cochain C., Williams J.W., Wolf D., Soehnlein O., Robbins C.S., Monaco C., Park I., McNamara C.A., Binder C.J., Cybulsky M.I., Scipione C.A., Hedrick C.C., Galkina E.V., Kyaw T., Ghosheh Y., Dinh H.Q., Ley K. Meta-Analysis of Leukocyte Diversity in Atherosclerotic Mouse Aortas. Circ Res. 2020;127(3):402-426. DOI: 10.1161/CIRCRESAHA.120.316903.

3. Wolf D., Ley K. Immunity and Inflammation in Atherosclerosis. Circ Res. 2019;124(2):315-327. DOI: 10.1161/CIRCRESAHA.118.313591.

4. Marchini T., Mitre L.S., Wolf D. Inflammatory Cell Recruitment in Cardiovascular Disease. Front Cell Dev Biol. 2021;9:635527. DOI: 10.3389/fcell.2021.635527.

5. Libby P., Everett B.M. Novel Antiatherosclerotic Therapies. Arterioscler Thromb Vasc Biol. 2019;39(4):538-545. DOI: 10.1161/ATVBAHA.118.310958.

6. Fain J.N., Madan A.K., Hiler M.L., Cheema P., Bahouth S.W.Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology. 2004;145(5):2273-2282. DOI: 10.1210/en.2003-1336.

7. Fontana L., Eagon J.C., Trujillo M.E., Scherer P.E., Klein S. Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes. 2007;56(4):1010-1013. DOI: 10.2337/db06-1656.

8. Bodrova E.A., Tarasov A.A., Emel'janova A.L., Lekareva I.V., Babaeva A.R. Assessment of the link between pro-inflammatory cytokines and structural and functional disorders of the myocardium in metabolic syndrome. Journal of Volgograd State Medical University. 2019;4 (72):53-59 (in Russ.). DOI: 10.19163/1994-9480-2019-4(72)-53-59. EDN: JLELRV.

9. Ridker P.M., Thuren T., Zalewski A., Libby P.Interleukin-1β inhibition and the prevention of recurrent cardiovascular events: rationale and design of the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). Am Heart J. 2011;162(4):597-605. DOI: 10.1016/j.ahj.2011.06.012.

10. Gomes V., Gomes M.B., Tibirica E., Lessa M.A. Post-operative endothelial dysfunction assessment using laser Doppler perfusion measurement in cardiac surgery patients. Acta Anaesthesiol Scand. 2014;58(4):468-477. DOI: 10.1111/aas.12286.

11. Abrard S., Fouquet O., Riou J., Rineau E., Abraham P., Sargentini C., Bigou Y., Baufreton C., Lasocki S., Henni S. Preoperative endothelial dysfunction in cutaneous microcirculation is associated with postoperative organ injury after cardiac surgery using extracorporeal circulation: a prospective cohort study. Ann Intensive Care. 2021;11(1):4. DOI: 10.1186/s13613-020-00789-y.

12. Kuznetsov M.R., Khaitov M.R., Turkin P.Yu., Moskalenko E.P., Pinegin B.V. The role of disorders of humoral and cellular immunity in the genesis of vascular anastomosis stenosis after reconstructive interventions on the arteries of the pelvis and lower extremities.Russian Journal of Thoracic and Cardiovascular Surgery. 2005;(2):29-33 (in Russ.). EDN: HRXSHH

13. Kryukov E.V., Shakhnovich P.G., Tagirova G.K., Kazakov S.P., Shibina L.V. Search for modern laboratory diagnostic predictors of the effectiveness of percutaneous coronary intervention in patients with coronary artery disease.Russian Cardiology Bulletin. 2020;15(S):55-56 (in Russ.). EDN: ZMXXBK

14. González-Gay M., López-Martínez R., Busto-Suárez S., Riedemann-Wistuba M.E., Menéndez-Herrero M.Á., Álvarez-Marcos F., Alonso-Pérez M., Alonso-Arias R. Immunological Aspects Involved in the Degeneration of Cryopreserved Arterial Allografts. Front Surg. 2020;7:616654. DOI: 10.3389/fsurg.2020.616654.

15. National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities. 2019. 89 p. (in Russ.)