State of antioxidant, pro-oxidant and endothelial systems in patients with chronic critical lower limb ischemia and high risk of reperfusion-reoxygenation complications
Background. Obliterating atherosclerosis of the peripheral arterial vessels accounts for more than 20 % of cases of cardiovascular pathology, that is more than in 3 % of the total population. Despite the large experience of performing operative arterial interventions, the 3year ability of the femoral subcutaneous shunts does not exceed 80 %. The frequency of reocclusion of iliac arteries is from 6 to 42 %. The purpose of the research was to study the features of the oxidant, prooxidant and endothelial systems in patients with chronic critical lower limb ischemia. Materials and methods. The work is based on the analysis of complex examination and surgical treatment of 220 patients with obliterating atherosclerosis of aorta and main arteries of the lower extremities. The patients were divided into two groups in terms of volume of surgical revascularization of femoropopliteal arteries. In the first group of patients, operative intervention included onestage reconstruction of the aortafemoral and femoropopliteal segments, in patients of the second group, the reconstruction of the indicated segments was performed in two stages. The activity of the components of the prooxidantantioxidant system was determined using spectrophotometric methods. Results. Investigations of the activity of freeradical oxidation demonstrated that the processes involving the tissues of the lower limbs, due to the influence of oxygen free radicals on them, not only activate free radical processes, but can also enhance the processes of damaging effects on the tissue cells and, moreover, on the endothelial system. Conclusions. The risk of reperfusion complications in the postoperative period in patients is confirmed by the high level of the inflammatory response. When revascularization occurs, the destruction, detachment of endothelial cells, the spread of endothelial cellcell contacts contributes to increase of penetration of the endothelial layer.
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