Получена: 03/05/2023/ Принята: 05/09/2023 / Опубликована online: 30/10/2023
УДК 616.13.002.2-004.6:616-005.6
10.53511/PHARMKAZ.2023.75.25.012
Е.Е. ВРУЧИНСКИЙ 2, Е.М. ТУРГУНОВ 1
1 НАО Медицинский университет Караганды, Караганда, Казахстан
2 PhD студент 2 года обучения по программе 8D10100 «Медицина»,
НАО Медицинский университет Караганды, Караганда, Казахстан
ОБЛИТЕРИРУЮЩИЙ АТЕРОСКЛЕРОЗ КАК ПРЕДИКТОР ТРОМБОЗА АРТЕРИЙ
НИЖНИХ КОНЕЧНОСТЕЙ (ОБЗОР ЛИТЕРАТУРЫ)
Резюме: Атеросклероз представляет собой хроническое воспалительное заболевание артериальной стенки, которое может вызывать острые атеротромботические явления (например острый
тромбоз артерий нижних конечностей) в результате разрыва или эрозии бляшки. На сегодняшний
день это самое распространенное заболевание артерий. Несмотря на распространенность атеросклероза артерий нижних конечностей и его влияние на неблагоприятные клинические исходы, заболевания периферических артерий недостаточно изучены и недостаточно признаны по сравнению
с другими атеросклеротическими заболеваниями такими, как инфаркт миокарда и инсульт . Таким
образом, ЗПА признается все более глобальной проблемой, которая все чаще приводит к таким осложнениям как острая ишемия н\конечностей , критическая ишемия нижних конечностей и инвалидизации пациентов .В данном обзоре представлен обзор достижений в понимании этиологии, патогенеза, гистопатологии атеротромбоза , а также результаты современных исследований молекулярных механизмов, лежащих в основе патогенеза тромбоза на клиническом и фундаментальном уровнях. Несмотря на высокотехнологиный подход к проблеме и методы оперативных вмешательств периоперационная летальность у этой группы больных достигает 20%, частота ампутаций – от 15% до 50%. 30-дневная смертность, даже в случае хирургического успеха и восстановления кровотока, остается высокой и составляет 10–15%
Статья посвящена комплексному обзору проблемы атеросклероза и острой ишемии нижних конечностей, составленному с учетом классического понимания морфологических изменений, клинической картины, методов диагностики и современных методов лечения, дополненного современными
тенденциями мировых исследований.
Ключевые слова: атеросклероз, тромбоз артерий нижних конечностей, патогенез, лечение тромбоза, методы прогнозирования.
СПИСОК ЛИТЕРАТУРЫ
1 Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, et al. 2016 AHA/
ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart
Association task force on clinical practice guidelines.Circulation. 2017; 135:e726–e779. doi: 10.1161/CIR.0000000000000471LinkGoogle Scholar
2 Fowkes, F Gerald R.Rudan, Diana Rudan, Igor Aboyans, Victor Denenberg, Julie O McDermott, Mary M.Norman, Paul E Sampson, Uchechukwe KAWilliams,
Linda J Mensah, George A Criqui, Michael H. Comparison of
3 global estimates of prevalence and risk factors for peripheral artery disease in
4 2000 and 2010: a systematic review and analysis. Volume 382, ISSUE 9901,
5 P1329-1340, oktober 19, 2013/Crossref DOI link: https://doi.org/10.1016/S0140-6736(13)61249-0
6 Criqui MH, Aboyans V. Epidemiology of peripheral artery disease.Circ Res. 2015; 116:1509–1526. doi: 10.1161/CIRCRESAHA.116.303849 Link Google
Scholar
7 Hess CN, Norgren L, Ansel GM, Capell WH, Fletcher JP, Fowkes FGR, Gottsäter A, Hitos K, Jaff MR, Nordanstig J, Hiatt WR. A Structured Review of
Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral
Artery Disease) Initiative. Circulation. 2017 Jun 20;135(25):2534-2555. doi: 10.1161/CIRCULATIONAHA.117.024469. Erratum in: Circulation. 2017 Nov
7;136(19):e347. PMID: 28630267.
8 Desai, Urvi Kharat, AkshayHess, Connie N.Milentijevic, DejanLaliberté, François , PeterBenson, JohnLefebvre, PatrickHiatt, William R.Bonaca, Marc P.
Incidence of Major Atherothrombotic Vascular Events among Patients with Peripheral Artery Disease after Revascularization. Annals of Vascular Surgery.
Volume 17, pp.201-226, August 2021
9 doi.org/10.1016/j.avsg.2021.02.025
10 Michael H. Criqui, MD Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions A Scientific
Statement From the American Heart Association Circulation. 2021;144:e171–e191. DOI: 10.1161/CIR.0000000000001005
11 Teodoro C, Bertanha M, Girard FPCM, Sobreira ML, Yoshida RA, Moura R, Jaldin RG, Yoshida WB. Results of treatment of acute occlusions of limb
arteries at a university hospital – retrospective study. J Vasc Bras. 2020 Nov 16;19:e20200031. doi: 10.1590/1677-5449.200031. PMID: 34211514; PMCID:
PMC8218016.
12 L.A. Bokeria, A.V. Pokrovsky and others.National guidelines for the study of patients with identification of arteries at risk of extremities, Moscow, 2013. P.
10-36
13 Bokaryov I.N., Popova L.V. Modern problems of arteries and veins thromboses.Journal of Practical Medicine‘6 (82) September 2014 P.13-17
14 Gadeev A.K., Bredikhin R.A. Treatment of patients with acute lower limb ischemia: selective thrombolysis or open surgery? // Angiology and vascular
surgery. 2015. V. 21. No. 4. S. 37-41.
15 Myrcha, P.; Kozak, M.; Myrcha, J.; Ząbek, M.; Rocha-Neves, J.; Głowiński, J.; Hendiger, W.; Woźniak, W.; Taranta, I. Clinical Characteristics and Predictors
of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically. Int. J. Environ. Res. Public Health 2023, 20, 3877. https://doi.
org/10.3390/ijerph20053877
16 Di Minno G, Spadarella G, Cafaro G, Petitto M, Lupoli R, Di Minno A, de Gaetano G, Tremoli E. Systematic reviews and meta-analyses for more profitable
strategies in peripheral artery disease. Ann Med. 2014 Nov;46(7):475-89. doi: 10.3109/07853890.2014.932618. Epub 2014 Jul 21. PMID: 25045928; PMCID:
PMC4245179.
17 Song P, Fang Z, Wang H, Cai Y, Rahimi K, Zhu Y, Fowkes FGR, Fowkes FJI, Rudan I. Global and regional prevalence, burden, and risk factors for carotid
atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health. 2020;8:e721–e729. doi: 10.1016/S2214-109X(20)30117-0
Crossref. PubMed.
18 Lambert MA, Belch JJ. Medical management of critical limb ischaemia: where do we stand today? J Intern Med. 2013;274:295–307. [Google Scholar]
19 Davies MG. Critical limb ischemia: epidemiology. Methodist Debakey Cardiovasc J. 2012;8:10–14. [Google Scholar]
20 Howard D.P.Banerjee A.Fairhead J.F.Hands L.Silver L.E.Rothwell P.M.Oxford Vascular Study. Population-based study of incidence, risk factors, outcome,
and prognosis of ischemic peripheral arterial events: implications for prevention.Circulation. 2015; 132: 1805-1815Scopus (92). PubMed. Crossref. Google
Scholar
21 Kuznetsov M.R., Yasnopolskaya N.V., Vinokurov I.A., Sysoev V.M. Mikhailichenko V.Yu., Samarin S.A. Possibilities of simultaneous surgical interventions
in acute ischemia of the lower extremities. Journal: Modern problems of science and education. – 2020. – No. 6 DOI:10.17513/spno.30372
22 Stöger JL, Gijbels MJ, van der Velden S, Manca M, van der Loos CM, Biessen EA, Daemen MJ, Lutgens E, de Winther MP. Distribution of macrophage
polarization markers in human atherosclerosis. Atherosclerosis. 2012 Dec;225(2):461-8. doi: 10.1016/j.atherosclerosis.2012.09.013. Epub 2012 Sep 26.
PMID: 23078881
23 Assotsiatsiya serdechno-sosudistykh khirurgov Rossii. Rossiiskoe nauchnoe obshchestvo kardiologov. Natsional‘nye Rekomendatsii po Vedeniyu Vzroslykh
Patsientov s Anevrizmami Bryushnoi Aorty i Arterii Nizhnikh Konechnostei. Moscow. 2011;140. (In Russ.).
24 Van D, Boesmans E, Defriagne J. Acute limb ischemia. Rev Med Liege. 2018;73(5-6):304-311
25 Santistevan J. Acute Limb Ischemia. Emerg Med Clin North Am. 2017;35(4):889-909. https://doi.org/10.1016/j.emc.2017.07.006
26 Moreno P. Pathohosiology of atherothrombosis. In atherothrombosis: The global approach for a Global Disease. Hightlights monograph from an international
expect meeting on atherothrombosis. — 1998 January 26-27, Phenix. — P. 1-4
27 de Athayde Soares R, Matielo MF, Brochado Neto FC, Cury MVM, Duque de Almeida R, de Jesus Martins M, Pereira de Carvalho BV, Sacilotto R. Analysis
of the results of endovascular and open surgical treatment of acute limb ischemia. J Vasc Surg. 2019 Mar;69(3):843-849. doi: 10.1016/j.jvs.2018.07.056. Epub
2019 Jan 22. PMID: 30679009.
28 Byrne R.M.Taha A.G.Avgerinos E.Marone L.K.Makaroun M.S.Chaer R.A.Contemporary outcomes of endovascular interventions for acute limb ischemia.J
Vasc Surg. 2014; 59: 988-995
29 Devine EB,Alfonso-Cristancho R,Yanez ND,et al.Effectiveness of a medical vs. revascularization intervention for intermittent leg claudication based on
patient-reported outcomes. JAMA Surg. 2016; 151e162024 Scopus (16).PubMed.Crossref.Google Scholar.
30 Gadeev A.K., Bredikhin R.A. Treatment of patients with acute lower limb ischemia: selective thrombolysis or open surgery? // Angiology and vascular
surgery. 2015. V. 21. No. 4. S. 37-41.
31 Shamoyan G.M., Strelkova A.A. Treatment of patients with acute ischemia of the lower extremities: selective thrombolysis or open surgical interventions //
Topical issues of medicine in modern conditions: a collection of scientific papers based on the results of the III international scientific and practical conference.
2017. S. 121-123.
32 Maksimov A.V., Gaisina E.A., Nuretdinov R.M. Regional thrombolysis in acute ischemia of the lower extremities // Practical Medicine. 2018. No. 7-2. pp.
55-58.
33 Kerimov Kh.R., Gerasin A.Yu., Kazakov Yu.I., Kazakov A.Yu. Improving the results of surgical treatment of patients with acute arterial occlusion of the lower
extremities and long periods of limb ischemia // Tverskoy Medical Journal. 2018. No. 6. S. 69-70
34 Bonaca MP,Gutierrez JA,Creager MA et al.Acute limb ischemia and outcomes with vorapaxar in patients with peripheral artery disease: results from the
trial to assess the effects of vorapaxar in preventing heart attack and stroke in patients with atherosclerosis-thrombolysis in myocardial infarction 50 (TRA2°PTIMI 50).Circulation. 2016; 133: 997-1005 Scopus (138).PubMed.Crossref.Google.Scholar
35 Jones WS, Baumgartner I, Hiatt WR et al. Ticagrelor compared with clopidogrel in patients with prior lower extremity revascularization for peripheral artery
disease.Circulation. 2017; 135: 241-250 Scopus (91).PubMed.Crossref.Google Scholar
36 Howard D.P.Banerjee A.Fairhead J.F.Hands L.Silver L.E.Rothwell P.M.Oxford Vascular Study. Population-based study of incidence, risk factors, outcome,
and prognosis of ischemic peripheral arterial events: implications for prevention.Circulation. 2015; 132: 1805-1815Scopus (92). PubMed. Crossref. Google
Scholar
37 Arbanasi, E.M.; Muresan, A.V.; Cosarca, C.M.; Kaller, R.; Bud, T.I.; Hosu, I.; Voidazan, S.T.; Arbanasi, E.M.; Russu, E. Neutrophil-to-Lymphocyte Ratio and
Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia. Life 2022, 12, 822. [Google Scholar] [CrossRef]
38 Myrcha, P.; Kozak, M.; Myrcha, J.; Ząbek, M.; Rocha-Neves, J.; Głowiński, J.; Hendiger, W.; Woźniak, W.; Taranta, I. Clinical Characteristics and Predictors
of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically. Int. J. Environ. Res. Public Health 2023, 20, 3877. https://doi.
org/10.3390/ijerph20053877
39 Di Minno G, Spadarella G, Cafaro G, Petitto M, Lupoli R, Di Minno A, de Gaetano G, Tremoli E. Systematic reviews and meta-analyses for more profitable
strategies in peripheral artery disease. Ann Med. 2014 Nov;46(7):475-89. doi: 10.3109/07853890.2014.932618. Epub 2014 Jul 21. PMID: 25045928; PMCID:
PMC4245179.
40 Violi F., Davy G., Hiatt W., Lip G.Yu., Corazza G.R., Perticon F. et al. The prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial
fibrillation: implications for risk and therapy. J Am Coll Cardiol. 2013; 62:2255–6.
41 Felicity B. Smith, J.Michael Connor : Relationship of the platelet glycoprotein PlA and fibrinogen T/G+1689 polymorphisms with peripheral arterial disease
and ischaemic heart disease; Thrombosis research VOLUME 112, ISSUE 4, P209-216, 2003 DOI:https://doi.org/10.1016/j.thromres.2003.11.010
42 Vazquez F, Rodger M, Carrier M, Le Gal G, Reny JL, Sofi F, Mueller T, Nagpal S, Jetty P, Gandara E. Prothrombin G20210A mutation and lower extremity
peripheral arterial disease: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2015 Aug;50(2):232-40. doi: 10.1016/j.ejvs.2015.04.033. Epub
2015 Jun 16. PMID: 26092622.
43 Damir Vakhitov, Sari Tuomisto, Mika Martiskainen. Bacterial signatures in thrombus aspirates of patients with lower limb arterial and venous thrombosis,Journal
of Vascular Surgery,Volume 67, Issue 6,2018,Pages 1902-1907,ISSN07415214,https://doi.org/10.1016/j.jvs.2017.05.090.
44 V.A. Zelinskiy, O.V. Isaulov, M.V. Melnikov, Thrombosis of the arteries of the pelvis and lower extremities with calcification of the abdominal aorta:features
of the clinical course and tactics of treatment. Kuban Scientific Medical Bulletin No. 4 (139) 2013
