Intraoperative endothelial dysfunction and hemocoagulative status in patients with atherosclerotic occlusion of the aorto-iliac-femoral basin and a high risk of postoperative complications
DOI:
https://doi.org/10.11603/2414-4533.2023.3.14148Keywords:
atherosclerosis, endothelial dysfunction, hemocoagulationAbstract
The aim of the work: to reveal the effect of revascularization of the aorto-iliac-femoral basin on the state of endothelial dysfunction and the hemocoagulation system of patients with a high risk of developing postoperative complications.
Materials and Methods. 78 patients with atherosclerotic occlusion of the aorto-iliac-femoral basin were included in the study. In 41 of them, Stage 3 of chronic arterial insufficiency (CAI) of the lower extremities was detected, in 37 – Stage 4 of CAI was diagnosed (according to Fontaine’s classification). The level of risk of developing postoperative complications was determined according to the classification of B. P. Selskyi et al. (2022), according to which it was high and very high in 40 cases, and 38 patients had moderate and high risk of development of postoperative complications. In all patients, the state of endothelial dysfunction and the level of indicators of the coagulation and aggregative systems were assessed before the operation and after the revascularization operation.
Results and Discussion. When analysing the results of the study of the state of endothelial dysfunction in patients of two groups, it was established that already at the pre-operative stage, a significant difference in the parameters characterizing endothelial dysfunction was found.
In the conducted study, it was found that in Group 2, patients with a high and very high risk of developing postoperative complications, both at the pre-operative stage and after revascularization surgery, had a higher level of endothelial dysfunction than patients with moderate and high the risk of postoperative complications of Group 1. It should be noted that the level of endothelial dysfunction according to its individual indicators both at the preoperative stage and after the revascularization in patients of Group 2 was 1.2 – 1.6 (р < 0.05) and 1.1 – 1 .5 (p < 0.05) times higher in comparison with a similar level of endothelial dysfunction at the stages of surgical treatment of patients of Group 1.
When analysing the level of the coagulation system, it was found that the level of the hemocoagulation system of the blood at the stages of surgical treatment of the pathology corresponds to changes in the level of endothelial dysfunction in the process of revascularization of the aorto-iliac-femoral basin. Surgical intervention on the main vessels contributes to the formation of a hypercoagulable state of blood due to tissue factors and vascular factors of the blood clotting system, the latter of which largely depend on the level of endothelial dysfunction. The state of the blood coagulation system corresponds to the level of risk of developing postoperative complications: in patients of Group 2 with a high and very high risk of postoperative complications, in the early postoperative period, the content of fibrinogen, soluble fibrin monomer complexes (SFMC), fibrinopeptide A (FPA), fibrin degradation products (FDP) was 1.4 – 2.4 (p < 0,05) times higher, while plasma recalcification time (PRT) was 1.5 (p < 0.05) times lower. In patients of Group 1 with a moderate and high risk of postoperative complications, the indicated parameters of the coagulation system increased 1.3 – 1.7 (p < 0.05) times with a shortening of the PRT by 1.3 (p < 0.05) times.
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