Functional activity of the endothelium and immune status in atherosclerotic lesions of the aorto-iliac segment and revascularization

Objective. The aim of the study is the evaluation of endothelial functional activity and immune status in systemic and local blood flow in atherosclerotic lesions of the aorto-iliac segment after open and endovascular interventions and establishing the relationship with the lesion class. 

Materials and methods. The study included 190 patients with lesions of the aorto-iliac segment. Depending on the type of surgical intervention, patients were divided into two groups: group I (n=97) - patients who underwent aorto-femoral bypass surgery, group II (n=93) - patients who underwent TRANS-balloon angioplasty with stenting of the iliac arteries. 

Results. Violations of the functional state of the endothelium and the immune status in the systemic and local blood flow, which do not correlate with the TASC II lesion class (TransAtlantic Inter-Society Consensus II), were revealed. There were differences in the factors of endothelial damage (in patients of group II before surgery, the level of homocysteine in the systemic blood flow, oxidized low-density lipoproteins in the systemic and local blood flow), hemostatic form of endothelial dysfunction (in group I, inhibitor of tissue plasminogen activator type I (PAI-1) in the systemic and tissue plasminogen activator (t-PA) in the local blood flow) and apoptosis (higher in group I in the systemic and local blood flow). During revascularization of the aorto-iliac segment, there were violations of the hemostatic form of endothelial dysfunction in group II with an increase in PAI-1 by 14.8% (p<0.001) in the systemic blood flow and by 1.9 times (p<0.001) in the revascularized arterial segment compared to group I. In group II after revascularization was significantly higher the immunoglobulins (Ig) class A in system and the circulating immune complexes, interleukins 1 (IL-1) in local blood flow and lower levels of IgM, interleukins 6 (IL-6), IL-1 in system and IgA, IgM, IL-6 in local blood flow compared with I group. 

Conclusion. The study of the features of the functional state of the endothelium and the immune status will optimize the management strategies of patients after various types of revascularization interventions on the aorto-iliac segment.

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