title: Plasminogen activator inhibitor-1 levels and activity decrease after intervention in patients with critical limb ischaemia.
abstract: OBJECTIVE
  Patients with peripheral arterial occlusive disease (PAOD), in particular critical limb ischaemia (CLI), carry a high risk of thrombotic events. We hypothesised that patients undergoing conservative, endovascular, or open surgical treatment for CLI have increased levels of plasminogen activator inhibitor-1 (PAI-1), leading to a prothrombotic state. The objective was to determine levels of PAI-1 in patients with acute or chronic PAOD/CLI.
  
  
  METHODS
  Thirty-two patients with a median age of 74 (49-90) years were included. Three underwent thrombolysis for acute limb-threatening ischaemia. Twenty-six patients with chronic ischaemia received endovascular (n = 20) or open (n = 6) surgical treatment. Three were treated conservatively. Biomarkers and ankle brachial index (ABI) were measured before and up to 1 month after intervention. Patency was studied with repeated duplex ultrasound.
  
  
  RESULTS
  Ankle pressure and ABI improved after intervention (p < .001). C-reactive protein (CRP) increased from a median of 7.90 mg/L at baseline to 31.5 on day 1 (p < .001), 28.0 on day 6 (p < .001), and returned to baseline levels on day 30. PAI-1 antigen and activity decreased from day 6 and onwards post-intervention compared with baseline (p < .05). A great individual variability in PAI-1 antigen and activity was observed. Although most actively treated patients had normal PAI-1 activity, 11/29 (38%) were above that level of normality at baseline, 10/24 (42%) on day 1, 3/23 (13%) on day 6, and 5/27 (19%) on day 30 after intervention.
  
  
  CONCLUSIONS
  Endovascular and open surgical treatment resulted in improved ankle pressure and ABI. The intervention was followed by a transient increase in CRP and a sustained reduction in PAI-1 levels and activity.
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. martin@bjorck.pp.se
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.forename: M
authors.initials: M
authors.lastname: Lepkowska Eriksson
authors.forename: A
authors.initials: A
authors.lastname: Bylock
authors.forename: J
authors.initials: J
authors.lastname: Steuer
authors.forename: A
authors.initials: A
authors.lastname: Wanhainen
authors.forename: B C L
authors.initials: BC
authors.lastname: Carlsson
authors.forename: D
authors.initials: D
authors.lastname: Bock
authors.forename: B
authors.initials: B
authors.lastname: Kragsterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016638:Critical Illness; D015536:Down-Regulation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D011237:Predictive Value of Tests; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
chemical_list: D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D002097:C-Reactive Protein
keywords: Critical limb ischaemia (CLI); Inflammation; Peripheral arterial occlusive disease (PAOD); Plasminogen activator inhibitor-1 (PAI-1); Thrombosis; Treatment