Comprehensive assessment of markers of apoptosis and cell proliferation during progression of atherosclerosis after surgery in patients with peripheral arterial disease.

Background: Determination of predictors that can affect development of atherosclerosis progression in the postoperative period is an urgent problem in vascular surgery. Objectives: Integrated assessment of markers of apoptosis and cell proliferation in atherosclerotic lesions and their progression after surgery in patients with peripheral arterial diseases. Methods: The investigation included 30 patients with stage IIB-III peripheral arterial disease. All patients have undergone open surgical interventions on the arteries of the aorto-iliac and femoral-popliteal segments. During these interventions, intraoperative specimens were obtained from the vascular wall with atherosclerotic lesions. The following values were evaluated: VEGF А165, PDGF BB, and sFas. Samples of normal vascular wall were obtained from post-mortem donors and used as a control group. Results: The levels of Bax and p53 were increased (p<0.001) in samples from arterial wall with atherosclerotic plaque, while sFas values were reduced (p<0.001), compared to their levels in control samples. Values of PDGF BB and VEGF A165 were 1.9 and 1.7 times higher in atherosclerotic lesion samples (p=0.001), in comparison with the control group. The levels of p53 and Bax were increased against a background of reduced sFas levels in samples with progression of atherosclerosis compared to their baseline values in samples with atherosclerotic plaque (p<0.05). Conclusions: Initially increased values of the Bax marker against a background of reduced sFas values in vascular wall samples from patients with peripheral arterial disease is associated with risk of atherosclerosis progression in the postoperative period.

Contexto: A determinação de preditores que possam influenciar o desenvolvimento da progressão da aterosclerose no período pós-operatório é um problema urgente em cirurgia vascular. Objetivos: Realizar uma avaliação integral de marcadores de apoptose e proliferação celular nas lesões ateroscleróticas e sua progressão após cirurgia em pacientes com doenças arteriais periféricas. Métodos: A investigação incluiu 30 pacientes com doenças arteriais periféricas de estágio IIB-III. Todos os pacientes foram submetidos a intervenções operatórias abertas nas artérias dos segmentos aorto-ilíaco e fêmoro-poplíteo. Durante a intervenção, foi obtido material intraoperatório da parede vascular com lesões ateroscleróticas. Foram avaliados os seguintes valores: VEGF A165, PDGF BB e sFas. Como grupo controle, amostras de parede vascular normal foram obtidas de doadores post-mortem. Resultados: O nível de Bax e p53 (p < 0,001) em amostras de parede arterial com placa aterosclerótica estava elevado em meio a valores reduzidos de sFas (p < 0,001) em comparação ao grupo controle. Os valores de PDGF BB e VEGF A165 foram 1,9 e 1,7 vezes maiores, respectivamente, nas amostras com lesão aterosclerótica (p = 0,001) do que no grupo controle. O nível de Bax e p53 e Bax estava elevado no contexto de nível reduzido de sFas em amostras com progressão da aterosclerose em comparação com seus valores basais em amostras com placa aterosclerótica (p < 0,05). Conclusões: Níveis inicialmente elevados do marcador Bax no contexto de valores reduzidos de sFas na parede vascular em pacientes com doença arterial periférica estão associados a risco de progressão da aterosclerose no período pós-operatório.

Comprehensive assessment of markers of apoptosis and cell proliferation during progression of atherosclerosis after surgery in patients with peripheral arterial disease / Avaliação integral de marcadores de apoptose e proliferação celular na progressão da aterosclerose após cirurgia em pacientes com doença arterial periférica

Abstract Background Determination of predictors that can affect development of atherosclerosis progression in the postoperative period is an urgent problem in vascular surgery. Objectives Integrated assessment of markers of apoptosis and cell proliferation in atherosclerotic lesions and their progression after surgery in patients with peripheral arterial diseases. Methods The investigation included 30 patients with stage IIB-III peripheral arterial disease. All patients have undergone open surgical interventions on the arteries of the aorto-iliac and femoral-popliteal segments. During these interventions, intraoperative specimens were obtained from the vascular wall with atherosclerotic lesions. The following values were evaluated: VEGF А165, PDGF BB, and sFas. Samples of normal vascular wall were obtained from post-mortem donors and used as a control group. Results The levels of Bax and p53 were increased (p<0.001) in samples from arterial wall with atherosclerotic plaque, while sFas values were reduced (p<0.001), compared to their levels in control samples. Values of PDGF BB and VEGF A165 were 1.9 and 1.7 times higher in atherosclerotic lesion samples (p=0.001), in comparison with the control group. The levels of p53 and Bax were increased against a background of reduced sFas levels in samples with progression of atherosclerosis compared to their baseline values in samples with atherosclerotic plaque (p<0.05). Conclusions Initially increased values of the Bax marker against a background of reduced sFas values in vascular wall samples from patients with peripheral arterial disease is associated with risk of atherosclerosis progression in the postoperative period.

Resumo Contexto A determinação de preditores que possam influenciar o desenvolvimento da progressão da aterosclerose no período pós-operatório é um problema urgente em cirurgia vascular. Objetivos Realizar uma avaliação integral de marcadores de apoptose e proliferação celular nas lesões ateroscleróticas e sua progressão após cirurgia em pacientes com doenças arteriais periféricas. Métodos A investigação incluiu 30 pacientes com doenças arteriais periféricas de estágio IIB-III. Todos os pacientes foram submetidos a intervenções operatórias abertas nas artérias dos segmentos aorto-ilíaco e fêmoro-poplíteo. Durante a intervenção, foi obtido material intraoperatório da parede vascular com lesões ateroscleróticas. Foram avaliados os seguintes valores: VEGF A165, PDGF BB e sFas. Como grupo controle, amostras de parede vascular normal foram obtidas de doadores post-mortem. Resultados O nível de Bax e p53 (p < 0,001) em amostras de parede arterial com placa aterosclerótica estava elevado em meio a valores reduzidos de sFas (p < 0,001) em comparação ao grupo controle. Os valores de PDGF BB e VEGF A165 foram 1,9 e 1,7 vezes maiores, respectivamente, nas amostras com lesão aterosclerótica (p = 0,001) do que no grupo controle. O nível de Bax e p53 e Bax estava elevado no contexto de nível reduzido de sFas em amostras com progressão da aterosclerose em comparação com seus valores basais em amostras com placa aterosclerótica (p < 0,05). Conclusões Níveis inicialmente elevados do marcador Bax no contexto de valores reduzidos de sFas na parede vascular em pacientes com doença arterial periférica estão associados a risco de progressão da aterosclerose no período pós-operatório.

Posterobasal left ventricular aneurysm after myocardial infarction with normal coronary arteries: Case-report.

We present a case of a 64-year-old woman with signs of debilitating condition including anginal chest pain, exertional dyspnea, and depression. The patient had previously suffered from a myocardial infarction after a loss of a close family member. Workup showed a posterobasal left ventricular aneurysm and moderate to severe mitral regurgitation in the absence of coronary atherosclerosis. Routine ultrasonography revealed abdominal aortic aneurysm and intraabdominal aortic deviation. The patient was immediately started on optimal medical treatment. On repeat assessment general condition was satisfactory, vital signs were normal, and investigations showed no signs of progressive heart failure or other significant clinical changes. Although prognosis in patients with myocardial infarction with normal coronary arteries is generally considered favorable, mechanical complications such as posterobasal left ventricular aneurysm with moderate to severe mitral regurgitation are possible.