Patologìâ (Dec 2013)
Morphological and immunohistochemical features of deobliterated femoral arteries and saphenous veins of patients with obliterating atherosclerosis of the lower extremities vessels in conditions of critical ischemia
Abstract
Introduction. Reconstructive surgery for atherosclerosis of the aorta and major arteries rapidly entered the offices of the daily practice of vascular surgery, due to the improved quality of life for patients in this age group. It should be noted that in almost half of patients with obliterating atherosclerosis (OA) in the performance of arterial reconstruction the great saphenous vein (GSV) appears unsuitable for its use as vein transplant. In such cases, for saving the limb synthetic material is used, which functions for a brief period due to non-compliance properties with the arterial wall. In recent years, for the prevention of stenosis rapid development in the area of sewing transplant to the tibial or popliteal arteries using venous insertions is suggested. However, in practice, quite often in these patients it is impossible to find even a short (5-10cm) venous segment to implant it between transplant and vein. In contrast, own desobliterated femoral artery (removal stenosis cylinder to internal or external elastic membrane) with appropriate anticoagulation drug support may be an interesting option for implantation in patients without adequate GSV. The purpose of this qualitative study was to assess the impact of desobliteration (to internal or to external elastic membrane) on the vascular matrix and antithrombotic properties of the wall of the femoral artery, compared with the great saphenous vein. Materials and Methods. Material of 21 male patients aged 50 to 73 years was studied, the total group of desobliterated femoral arteries (DFA) included two groups: the first - the DFA to the internal elastic membrane (n=8) and the second - DFA to the external elastic membrane (n=7). The control group consisted of 6 pieces of GSV. Primary monoclonal antibodies CD31, Ki-67, Collagen IV, aSM-1, Myosin, Desmin, MMP-9, TIMP-1 were used. Statistical analysis of data was carried out in the program SPSS Statistica 17.0. To establish a statistically significant relationship between the clinical and morphological features and the expression of markers nonparametric U-Mann-Whitney was used. Comparison of mean values was carried out using Student's criteria. A significant relationship was considered at p0.05).
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