Level of oxidized lipoproteins of low density and endothelial status in patients with objective atherosclerosis of lower limbs after reconstructive operations on aorto-iliacfemoral segmen

Abstract

Aim. . Evaluation of the relationship between the level of oxidized lipoproteins of low density (oxidized LDL) and endothelial status in the systemic and local blood flow in patients with obliterating atherosclerosis of the lowern extremities before and after reconstructive operations.
Materials and methods. The study included 68 patients with obliterating atherosclerosis of the arteries of the lower extremities, the average age was 57.9±0.88 years, with II B - III degree of chronic arterial insufficiency according to R. Fontaine – A.V. Pokrovsky, who were divided into three groups depending on the scope of the surgical intervention: 1 group had femoropopliteal shunting (n=32), 2 – aorto-femoral bypass (n=20), 3 – x-ray endovascular angioplasty and stenting of the iliac arteries (n=16). A correlation analysis was made between the content of oxidized LDL and markers of the endothelial status: the vascular endothelial type 1 adhesion molecule (sVCAM-1), Annexin V, the tissue type I plasminogen activator inhibitor (PAI-1), the tissue plasminogen activator (t-PA) in the systemic blood stream in the affected limb prior to surgery and in the early postoperative period.
Results. The level of oxidized LDL was closely associated with a violation of endothelial status. A correlation was found between oxidized LDL and sVCAM-1, both at the systemic level and in the affected limb, and this association persisted after reconstructive intervention, the most significant in patients after femoropopliteal bypass surgery. The relation between oxidized LDL and imbalance of fibrinolytic activity with an increase in prothrombotic potential was revealed for all types of reconstruction. Significant positive correlation between oxidized LDL and Annexin V as a marker of endothelial dysfunction was determined in patients after X-ray endovascular correction of the iliac segment and a weak negative correlation between oxidized LDL and Annexin V in the systemic and local blood flow in patients after open arterial reconstructions.
Conclusion. Oxidized LDL contribute to the disturbances of the endothelial status of the vascular bed in patients with obliterating atherosclerosis of the lower extremities, with the activation of inflammation, apoptosis, increased adhesion molecules, inhibition of fibrinolysis, and persistent after surgical correction of arterial hemodynamics both at the systemic level and in the affected limb.