Percutaneous angioplasty, endothelial markers, and fibrin turnover.
OBJECTIVE
A number of thrombotic mediators have been related to peripheral arterial disease in both epidemiological and pathological studies.


METHODS
We measured preoperative levels of fibrinogen, cross-linked fibrin degradation products (FDP), and the endothelial markers, von Willebrand factor (vWF), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI), in the venous blood of 43 claudicants undergoing percutaneous transluminal angioplasty (PTA). Samples were repeated 4 months later, and changes in the levels of thrombotic mediators were compared with ten controls undergoing angiography alone. Additional perilesional arterial samples were obtained from 11 of the patients.


RESULTS
Arterial sampling indicated that successful PTA led to an immediate fall in tPA levels and a rise in arterial vWF (p < 0.05), together with a trend toward a significant rise in cross-linked FDP levels. Only the increase in FDP following successful PTA (36 cases) (p < 0.05) was observed in 4-month postangioplasty venous samples, whereas all variables remained unchanged in cases of restenosis (4 patients) and in controls (all comparisons made by Wilcoxon matched pairs test).


CONCLUSIONS
These findings suggest that successful PTA in patients with intermittent claudication results in acute endothelial disturbance and increased fibrin turnover at the site of angioplasty and in sustained increases in fibrin turnover (as reflected by FDP levels). The observation that this increase in fibrin turnover is absent in cases of restenosis within 4 months of PTA merits further study to determine whether increases in fibrin turnover are necessary to maintain patency following PTA.
Woodburn
K R
KR
University Department of Medicine, Royal Infirmary, Glasgow, Scotland, United Kingdom.
Lowe
G D
GD
Pollock
J G
JG
Rumley
A
A
Reid
A W
AW
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery; D003251:Constriction, Pathologic; D004730:Endothelium, Vascular; D005260:Female; D005263:Femoral Artery; D005337:Fibrin / Q000032:analysis*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007083:Iliac Artery; D007383:Intermittent Claudication / Q000097:blood* / Q000628:therapy*; D008297:Male; D015849:Plasminogen Inactivators / Q000097:blood; D011150:Popliteal Artery; D010959:Tissue Plasminogen Activator / Q000097:blood; D014841:von Willebrand Factor / Q000032:analysis
D005338:Fibrin Fibrinogen Degradation Products; D015849:Plasminogen Inactivators; D014841:von Willebrand Factor; D005337:Fibrin; D010959:Tissue Plasminogen Activator