Analysis of pathomorphological, pathophysiological and clinical features of steno-occlusive and aneurysmal disease of the infrarenal part of aorta

Stenozantno-okluzivne promjene na aortoilijačnom segmentu (SOBA) uglavnom nastaju kao posljedica degenerativnih i inflamatornih aterosklerotskih promjena na zidu krvnog suda. U zadnje vrijeme sve je veći broj dokaza o inflamatornoj komponenti aterogeneze (Mulenix 2005; Zhongzhi, 2017). Aneurizmatska bolest aorte (ANBA) je lokalizovano trajno proširenje aorte čiji je dijametar bar 50% veći od normalnog promjera. ANBA je nedovojlno jasne etiologije. Opisani su najčešći uzroci: poremećaji vezivnog tkiva (Ehlers-Danlosov sindrom, Marfanov sindrom), degenerativni procesi, infekcija, inflamatorni arteritisi, disekcija itd (Davidović 2015; Humphrey 2012). Iako ima dosta podataka o značaju genetskih faktora koji determinišu i aterosklerozu i aneurizmatsku bolest, sve više je radova o značaju metaloproteinaza (Shapiro 1999) za nastanak i komplikacije ANBA. CILJ RADA: Cilj rada je da se uporede imunohistohemijski parametri, patomorfološke osobenosti, klinička slika i način liječenja bolesnika sa ANBA i obolelih od SOBA radi bolje determincije ova dva patološka stanja infrarenalnog segmenta abdominalne aorte MATERIJAL I METODE: Sprovedene su dvije studije: retrospektivna (72 bolesnika sa ANBA i 59 bolesnika sa SOBA) i prospektivna (30 ANBA i 30 SOBA bolesnika) u UKC RS Banjaluka (Klinika za vaskularnu hirurgiju) u periodu od 3 godine (1. 4. 2010 - 1. 4. 2013) . Retrospektivnom studijom su ispitivane demografske karakteristike (distribucija bolesnika po polu, životnom dobu), anamnestički podaci (klaudikacije, bolovi), faktori rizika i štetne navike (pušenje, alkoholizam), prateća oboljenja, laboratorijski nalazi (lipidni status), objektivni klinički nalaz pulsni status) , dopler indeksi i EHO ultrazvučni nalaz aorte, angiografija, metode hirurškog liječenja i rezultati neposrednog ishoda liječenja po ispitivanim grupama (ANBA i SOBA). Prospektivnom studijom su praćeni klinički (distribucija bolesnika po polu, životnoj dobi, kliničkoj slici, pulsnom statusu, dopler indeksima, kolor dupleks skenu aorte, angiografskom nalazu, diabetes mellitusu, hipertenziji, hiperlipidemiji, pušenju, alkoholizmu, sesilnom načinu života, hroničnoj opstruktivnoj bolesti pluća, hroničnoj renalnoj insuficijenciji, koronarnoj bolesti, cerebrovaskualrnim bolestima i vrsti operativnog zbrinjavanja) , laboratorijski (vrijednosti C-reaktivnog proteina, fibrinogena, homocisteina α 1 antitripsina), histološki (isječci zida infrarenalne aorte bojeni hemotoksilin-eozin i detektovani kristali holesterola, kalcifikacija, inflamatornog infiltrata) i imunohistohemijski parametri (koncentracije metaloproteinaza 2 i 9 (MMP-2 i MMP-9) i tkivnih inhibitora metaloproteinaza 2 i 9 (TIMP 1, TIMP 2) na 5 μm isječcima zida abdominalne aorte složenom tehnikom reakcije antigena i monoklonskih antitijela) kod bolesnika sa ANBA i SOBA...Steno-occlusive changes in the aortoilliac segment (AIOD) mainly occur due to degenerative and inflammatory atherosclerotic changes on the blood vessel wall. Lately, there has been increasing evidence suggesting the inflammatory component of atherogenesis (Mulenix 2005; Zhongzhi, 2017). Aneurysmatic aortic disease (AAA) is a localized permanent enlargement of the aorta whose diameter is at least 50% greater than the normal diameter. AAA does not have an undeniably clear etiology. The most common causes are: connective tissue disorders (Ehlers-Danlos syndrome, Marfan syndrome), degenerative processes, infections, inflammatory arteritis, dissection, etc. (Davidović 2015; Humphrey 2012). Although there is substantial data about the significance of genetic factors that determine both atherosclerosis and aneurysmal disease, more and more papers focus on the importance of metalloproteinases (Shapiro 1999) for the onset and complications of AAA. AIM OF WORK: The aim of the paper is to compare the immunohistochemical parameters, the pathomorphological characteristics, the clinical presentation, and the method of treating the patients with AAA and patients with AIOD, for better determination of these two pathological conditions of the infrarenal segment of the abdominal aorta. MATERIAL AND METHODS: Two studies were carried out: retrospective (72 patients with AAA and 59 patients with AIOD) and prospective (30 AAA and 30 AIOD patients) in UKC RS Banja Luka (Department of Vascular Surgery) for a period of 3 years (1.4 2010 - 1. 4. 2013). The retrospective study examined the demographic characteristics (distribution of patients by gender, age), anamnestic data (claudication, pain), risk factors and harmful habits (smoking, alcoholism), accompanying comorbidities, laboratory findings (lipid profile), objective clinical finding (pulse status), Doppler indexes and ECHO ultrasound findings of the aorta, angiography, methods of surgical treatment and results of immediate outcome of treatment by examined groups (AAA and AIOD)..

Long-term graft occlusion in aortobifemoral position

Background/Aim. Aortobifemoral (AFF) bypass is still the most common surgical procedure used in treatment of aortoiliac occlusive disease. One of the most common complications of AFF bypass procedure is long-term graft occlusion. The aim of this study was to determine the cause of long-term graft occlusion in AFF position, as well as the results of early treatment of this complication. Methods. This retrospective study, performed at the Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade, involved 100 patients treated for long-term occlusion of bifurcated Dacron graft which was ensued at least one year after the primary surgical procedure. Results. The most common cause of the longterm graft occlusion was the process at the level of distal anastomosis or below it (Z = 3.8, p = 0.0001). End-to-end type of proximal anastomosis has been associated with a significantly increased rate of long-term graft occlusion (Z = 2.2, p = 0.0278). Five different procedures were used for the treatment of long-term graft occlusion: thrombectomy and distal anastomosis patch plasty (46% of the cases); thrombectomy and elongation (26% of the cases); thrombectomy and femoropopliteal bypass (24% of the cases); crossover bypass (2% of the cases) and a new AFF bypass (2% of the cases). The primary early graft patency was 87%. All 13 early occlusions occurred after the thrombectomy associated with patch plasty of distal anastomosis. Thrombectomy with distal anastomosis patch plasty showed a statistically highest percentage of failures in comparison to thrombectomy with graft elongation, or thrombectomy with femoro-popliteal bypass (Z = 2 984, p = 0.0028). Redo procedures were performed in all the cases of early occlusions. In a 30-day follow-up period after the secondary surgery, 90 (90%) patients had their limbs saved, and above knee amputation was made in 10 (10%) patients. Conclusion. Long-term AFF bypass patency can be obtained by proximal end-to-end anastomosis on the juxtarenal part of aorta and distal anastomosis on the bifurcation of the common femoral, or on the deep femoral artery. [Projekat Ministarstva nauke Republike Srbije, br. 175008

Plasma cathepsin S is associated with high-density lipoprotein cholesterol and bilirubin in patients with abdominal aortic aneurysms

Background: Cathepsin S (CTSS) is a cysteine protease involved in atherogenesis. We compared the plasma CTSS as well as other biomarkers of atherosclerosis in patients with abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AOD), aiming to identify the underlying pathogenic mechanisms of the disease development. Also, we hypothesised that the level of plasma CTSS simultaneously increases with a decrease of plasma high-density lipoprotein cholesterol (HDL-C) values. Methods: 33 patients with AAA and 34 patients with AOD were included in this study. Results: There was no difference in the level of plasma CTSS between the two analysed groups (p=0.833). In the patients with AAA, the plasma CTSS was correlated with HDL-C (r = -0.377, p = 0.034) and total bilirubin (r = 0.500, p = 0.003) while, unexpectedly, it was not correlated with cystatin C (Cys C) (r = 0.083, p = 0.652). In the patients with AOD, the plasma CTSS correlated with triglycerides (r = 0.597, p lt 0.001), only. When the patients were divided according to HDL-C (with HDL-C lt = 0.90 and HDL-C >0.90 mmol/L), the plasma CTSS values differed among these groups (31.27 vs.25.61 mu g/L, respectively, p lt 0.001). Conclusions: These results provide the first evidence that CTSS negatively correlated with HDL-C and bilirubin in patients with AAA. It is possible that differences in the association of the CTSS and other markers of atherosclerosis can determine whether atherosclerotic aorta will develop dilatation or stenosis

Analysis of pathomorphological, pathophysiological and clinical features of steno-occlusive and aneurysmal disease of the infrarenal part of aorta

Stenozantno-okluzivne promjene na aortoilijačnom segmentu (SOBA) uglavnom nastaju kao posljedica degenerativnih i inflamatornih aterosklerotskih promjena na zidu krvnog suda. U zadnje vrijeme sve je veći broj dokaza o inflamatornoj komponenti aterogeneze (Mulenix 2005; Zhongzhi, 2017). Aneurizmatska bolest aorte (ANBA) je lokalizovano trajno proširenje aorte čiji je dijametar bar 50% veći od normalnog promjera. ANBA je nedovojlno jasne etiologije. Opisani su najčešći uzroci: poremećaji vezivnog tkiva (Ehlers-Danlosov sindrom, Marfanov sindrom), degenerativni procesi, infekcija, inflamatorni arteritisi, disekcija itd (Davidović 2015; Humphrey 2012). Iako ima dosta podataka o značaju genetskih faktora koji determinišu i aterosklerozu i aneurizmatsku bolest, sve više je radova o značaju metaloproteinaza (Shapiro 1999) za nastanak i komplikacije ANBA. CILJ RADA: Cilj rada je da se uporede imunohistohemijski parametri, patomorfološke osobenosti, klinička slika i način liječenja bolesnika sa ANBA i obolelih od SOBA radi bolje determincije ova dva patološka stanja infrarenalnog segmenta abdominalne aorte MATERIJAL I METODE: Sprovedene su dvije studije: retrospektivna (72 bolesnika sa ANBA i 59 bolesnika sa SOBA) i prospektivna (30 ANBA i 30 SOBA bolesnika) u UKC RS Banjaluka (Klinika za vaskularnu hirurgiju) u periodu od 3 godine (1. 4. 2010 - 1. 4. 2013) . Retrospektivnom studijom su ispitivane demografske karakteristike (distribucija bolesnika po polu, životnom dobu), anamnestički podaci (klaudikacije, bolovi), faktori rizika i štetne navike (pušenje, alkoholizam), prateća oboljenja, laboratorijski nalazi (lipidni status), objektivni klinički nalaz pulsni status) , dopler indeksi i EHO ultrazvučni nalaz aorte, angiografija, metode hirurškog liječenja i rezultati neposrednog ishoda liječenja po ispitivanim grupama (ANBA i SOBA). Prospektivnom studijom su praćeni klinički (distribucija bolesnika po polu, životnoj dobi, kliničkoj slici, pulsnom statusu, dopler indeksima, kolor dupleks skenu aorte, angiografskom nalazu, diabetes mellitusu, hipertenziji, hiperlipidemiji, pušenju, alkoholizmu, sesilnom načinu života, hroničnoj opstruktivnoj bolesti pluća, hroničnoj renalnoj insuficijenciji, koronarnoj bolesti, cerebrovaskualrnim bolestima i vrsti operativnog zbrinjavanja) , laboratorijski (vrijednosti C-reaktivnog proteina, fibrinogena, homocisteina α 1 antitripsina), histološki (isječci zida infrarenalne aorte bojeni hemotoksilin-eozin i detektovani kristali holesterola, kalcifikacija, inflamatornog infiltrata) i imunohistohemijski parametri (koncentracije metaloproteinaza 2 i 9 (MMP-2 i MMP-9) i tkivnih inhibitora metaloproteinaza 2 i 9 (TIMP 1, TIMP 2) na 5 μm isječcima zida abdominalne aorte složenom tehnikom reakcije antigena i monoklonskih antitijela) kod bolesnika sa ANBA i SOBA...Steno-occlusive changes in the aortoilliac segment (AIOD) mainly occur due to degenerative and inflammatory atherosclerotic changes on the blood vessel wall. Lately, there has been increasing evidence suggesting the inflammatory component of atherogenesis (Mulenix 2005; Zhongzhi, 2017). Aneurysmatic aortic disease (AAA) is a localized permanent enlargement of the aorta whose diameter is at least 50% greater than the normal diameter. AAA does not have an undeniably clear etiology. The most common causes are: connective tissue disorders (Ehlers-Danlos syndrome, Marfan syndrome), degenerative processes, infections, inflammatory arteritis, dissection, etc. (Davidović 2015; Humphrey 2012). Although there is substantial data about the significance of genetic factors that determine both atherosclerosis and aneurysmal disease, more and more papers focus on the importance of metalloproteinases (Shapiro 1999) for the onset and complications of AAA. AIM OF WORK: The aim of the paper is to compare the immunohistochemical parameters, the pathomorphological characteristics, the clinical presentation, and the method of treating the patients with AAA and patients with AIOD, for better determination of these two pathological conditions of the infrarenal segment of the abdominal aorta. MATERIAL AND METHODS: Two studies were carried out: retrospective (72 patients with AAA and 59 patients with AIOD) and prospective (30 AAA and 30 AIOD patients) in UKC RS Banja Luka (Department of Vascular Surgery) for a period of 3 years (1.4 2010 - 1. 4. 2013). The retrospective study examined the demographic characteristics (distribution of patients by gender, age), anamnestic data (claudication, pain), risk factors and harmful habits (smoking, alcoholism), accompanying comorbidities, laboratory findings (lipid profile), objective clinical finding (pulse status), Doppler indexes and ECHO ultrasound findings of the aorta, angiography, methods of surgical treatment and results of immediate outcome of treatment by examined groups (AAA and AIOD)..