Markers of the Development of the Reconstruction Area Restenosis After Endovascular Interventions in Lower Limbs Arteries

Restenosis of the reconstruction zone is one of the main postoperative complications of vascular reconstructions, which develops in 18–40% of cases and leads to an increase in the risk of limb loss to 20–25%. The search for new markers for predicting the development of this complication is an urgent problem today.

Aim of study. To assess the dynamics of markers of apoptosis and cell proliferation at different times after endovascular intervention and their role in the development of restenosis of the reconstruction zone in patients with peripheral arterial disease (PAD).

Material and methods. The clinical study included 30 patients with PAD stage III disease. After further examination, the patients underwent endovascular intervention on the arteries of the femoral-popliteal segment. If restenosis developed, the patients were re-operated. In patients before surgery, within the first hour, and then on days 1, 7, 14, 21, 30 after the operation, venous blood was taken to determine the markers Bax, sFas, PDGF BB using enzyme immunoassay.

Results. After endovascular intervention, the first wave of apoptosis was triggered with an increase in the amount of proapoptotic protein Bax (p=0,00003) from 1 to 24 hours, followed by a decrease by day 7 (p=0.0008) compared to the amount on day 1. The PDGF BB level increased from day 1 after surgery (p=0.03) with maximum values on day 7 (p=0.0002) compared to the level on day 1. Then the second wave was triggered with a peak decrease in the level of the apoptosis inhibitor sFas on day 21 (p=0.002). After 9-12 months, restenosis of the intervention zone with a return of limb ischemia developed in 10 patients. During the first hour (p=0.004) in patients with restenosis, the level of Bax protein was significantly increased, with an increase in the level of PDGF BB by day 7 (p=0.011), and sFas by day 21 (p=0.0001), PDGF BB by the end of 1 month (p=0.004) compared to values in patients without this complication.

Conclusion. 1. Endovascular intervention causes two waves of apoptosis in the postoperative period. The first wave is associated with an increase in Bax protein in the first hours, followed by an increase in PDGF BB on day 7. The second wave of apoptosis is due to a decrease in the inhibitor of apoptosis — sFas for 21 days against the background of the shift of the PDGF BB to the initial level. 2. An increase in Bax protein within the first hours after surgery in the course of PDGF BB growth on day 7 with an increased amount of sFas on day 21 leads and PDGF BB by the end of 1 month leads to the development of restenosis of the intervention area. 

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