LIPID PROFILE AND HEMORHEOLOGY DYNAMICS IN PATIENTS WITH LOWER EXTREMITY PERIPHERAL ARTERY DISEASE IN THE PREOPERATIVE AND POSTOPERATIVE PERIOD

• Main Authors: V. A. Lazarenko, E. A. Bobrovskaya, L. N. Belikov
• Format: Article
• Language: Russian
• Published: SINAPS LLC 2019-05-01
• Series: Arhivʺ Vnutrennej Mediciny
• Subjects: peripheral artery disease; lipid profile; hemostatic profile; reconstructive surgery
• Online Access: https://www.medarhive.ru/jour/article/view/930

The objective of the study was to evaluate the lipid and hemostatic profile in patients with peripheral artery disease of lower extremities at different levels of lesion and methods of surgery.Materials and methods. 330 male patients with peripheral artery disease of lower extremities arteries of II b — III degree were examined: group I consisted of 140 patients with lesions of the femoral-popliteal arterial segment, who underwent femoralpopliteal bypass surgery (58.64±7.73 years), group II — 97 patients with occlusive-stenotic lesions of the aorto-iliac segment, who underwent aortofemoral bypass surgery (56.82±6.69 years), group III — 93 patients with occlusive stenotic changes of the iliac arteries, who underwent transluminal balloon angioplasty and stenting of the iliac arteries. The examination of patients included general clinical, instrumental and laboratory methods with the assessment of lipid profile fractions and plasma-coagulation level of hemostasis.Results. The provided examination showed that patients with peripheral artery disease have disorders of the blood lipid profile, which have significant differences depending on the severity and localization of occlusive-stenotic lesions of the aorta and main arteries. Lipid imbalance persists after correction of arterial blood flow. Significant changes in the hemostatic profile in all groups in the postoperative period were revealed, which were characterized by hypercoagulation in the form of a significant increase in the concentration of fibrinogen, reducing the activity of antithrombin III, shortening of thrombin time in groups I and II and reducing spontaneous fibrinolysis in groups I and II. Thrombin time and spontaneous fibrinolysis in group III increased relative to preoperative values. Open interventions in the volume of femoral-popliteal bypass surgery were accompanied by a more pronounced inhibition of fibrinolysis in comparison with minimally invasive interventions, and in endovascular procedure the anticoagulant potential was more depressed. Open reconstruction of the iliac segment was associated with a large reduction in thrombin time, but less inhibition of anticoagulant potential, compared with endovascular technique, due to large damage to the endothelium.Conclusion. It is necessary to monitor the lipid and hemostatic profile both before and after surgery in patients, admitted to the hospital for reconstructive surgery on the aorta and main arteries of the lower extremities, in order to develop an effective personalized drug prevention of lower extremity peripheral artery disease progression and to prevent the development of thrombotic and stenotic complications of the arterial reconstruction zone.