Blood rheology and thrombotic mediators in peripheral arterial disease and revascularisation surgery

• Main Author: Woodburn, Kenneth Robert
• Published: University of Edinburgh 1994
• Subjects: 617
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.664001

Rheological parameters and levels of plasma fibrinogen, cross-linked fibrin degradation products (FDP's), von Willebrand Factor antigen (vWF), factor VII, and Plasminogen Activator Inhibitor (P.A.I.), were found to be altered in 219 patients with occlusive arterial disease undergoing revascularisation procedures, when compared with an age-matched random population sample. Elevated levels of some of these potential thrombotic mediators are associated with the angiographic severity of arterial disease on univariate analysis, while multivariate analysis indicates that log (FDP) is independently related to disease severity, and other thrombotic mediators show a trend towards significant independent association. Surgical relief of critical limb ischaemia in 82 of these patients returned the alterations in blood rheology to control levels, but plasma fibrinogen, vWF, P.A.I., and FDP levels remained significantly higher than in the population controls. Percutaneous angioplasty in 40 cases was associated with transient alterations in vWF and t.P.A. levels in arterial blood that may be a consequence of endothelial injury, and with a significant elevation in cross-linked FDP levels 3 months after successful angioplasty. This alteration in fibrin turnover may be related to restenosis following angioplasty. Elevated pre-operative plasma fibrinogen, vWF, and FDP's, were associated with graft occlusion and patient death on univariate analysis of 186 consecutive infra-inguinal bypass grafts, while multivariate analysis indicates that pre-operative plasma von Willebrand Factor levels (p < 0.001), systolic ankle pressure (p < 0.01), female sex (p = 0.03), and limb sepsis (p = 0.01), are all independently predictive of graft occlusion and patient death within 1 year following surgery.