Assessment of endothelial dysfunction for prevention of complications in patients with lesions of peripheral arteries

Pokrovsky A.V.¹, Kulbak V.A.^1,2, Kremenchugskaya T.A.², Fedorov E.E.³

1) Vascular Surgery Department, Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health,
2) Chair of Surgery of the Faculty of Fundamental Medicine, Moscow State University named after M.V. Lomonosov,
3) General Surgery Department, Vascular Unit, Municipal Clinical Hospital No 29 named after N.E. Bauman, Moscow, Russia

Background. Severity of endothelial dysfunction and impairments of the vasomotor function of arteries correlate with the degree of the development of atherosclerosis and the risk of cardiovascular complications. To date, poorly studied still remains the problem concerning alteration of the regulatory function of the endothelium in patients diagnosed with pronounced atherosclerotic lesions of peripheral arteries, as well as the impact of a surgical intervention on indices of endothelial dysfunction.

Patients and methods. Presented in the article are the results of preoperative study of the endothelial function by means of peripheral arterial tonometry (PAT) using the Endo PATTM 2000 device (Itamar Medical Ltd.) in a total of 74 patients undergoing surgical treatment at the Institute of Surgery named after A.V. Vishnevsky. The male-to-female ratio in the studied group was 1:2.52, with the patients’ average age amounting to 67±8 years. Of the 74 patients, 21 were subjected to a repeat examination performed at terms varying from 2 to 23 months postoperatively. Of these, 17 (80.95%) patients took statins. Fourteen (66.7%) patients had endured an operative intervention on carotid arteries and seven (33.3%) had been operated on for lesions of lower-limb arteries.

Results. The statistical analysis of the obtained findings revealed no significant differences of the indices of the endothelial function in the studied group between the genders, depending on age, smoking or taking statins. Neither were there statistically significant differences in the reactive hyperaemia index (RHI) amongst the patients with the involvement of one or several arterial basins. We did not reveal a direct relationship or regularity of the effect of a surgical intervention on the RHI values in the operated patients. This might be explained by the fact that the method of PAT to a greater degree assesses the state of the microvascular bed rather than that of large arteries.

KEY WORDS: endothelial dysfunction, reactive hyperaemia index, peripheral arterial tonometry, surgical treatment.

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