fibrin and Peripheral-Vascular-Diseases

Raised plasma fibrinogen levels and markers of fibrin turnover or endothelial disturbance are associated with cardiovascular disease.. This is a critical review of the English language literature relating to fibrinogen, fibrin degradation products and endothelial products in peripheral arterial disease and revascularization surgery.. Altered levels of plasma fibrinogen and endothelial products are associated with atherosclerosis and some studies have shown an association with poor outcome following revascularization surgery. Randomized clinical trials of therapies that modify thrombotic pathways in patients undergoing surgery for peripheral arterial occlusive disease are therefore required.

Topics: Arteriosclerosis; Biomarkers; Blood Vessel Prosthesis; Fibrin; Fibrinogen; Humans; Peripheral Vascular Diseases; Plasminogen Inactivators; Thrombosis; von Willebrand Factor

To evaluate the occurrence, size and composition of embolized debris captured during routine directional atherectomy using the SilverHawk device.. 15 consecutive eligible patients with a nonocclusive superficial femoral artery (SFA) were enrolled. Patients were included if they were > 18 years of age and had > or = 70% stenosis in the SFA. All lesions underwent plaque excision with the SilverHawk atherectomy device. A FilterWire EZ was used for distal protection and retrieval of embolized material. Specimens were collected separately from the filter basket and the SilverHawk atherectomy device's nosecone and were studied by a pathologist for number, size and composition.. Visible debris captured in the filter was found in the majority of patients 14/15 (93%). Clinically-significant debris was found in 7/15 (47%) patients. The proportion of captured debris ranged from 0.1-0.4 cm. Microscopy revealed that the shaved particles consisted predominantly of collagen, fibrin, lipid-laden macrophages, cholesterol and calcium. Analysis of the embolized material revealed a different composition, mostly consisting of collagen with fibrosis, cholesterol and macrophages.. In this single-center comparative study we have shown that during SilverHawk atherectomy of SFA lesions, distal embolization is universal. The debris captured in the filter is different in overall composition from the captured material in the nosecone of the SilverHawk device. Debris large enough to cause clinically-significant embolization, no-reflow and ischemia following SFA interventions occurred in nearly 50% of cases.

Topics: Aged; Atherectomy; Calcium; Cholesterol; Collagen; Debridement; Embolism; Female; Femoral Artery; Fibrin; Humans; Macrophages; Male; Middle Aged; Peripheral Vascular Diseases; Retrospective Studies; Risk Factors

Topics: Blood Coagulation; Cardiovascular Diseases; Family; Fibrin; Genetic Predisposition to Disease; Humans; Intermittent Claudication; Pedigree; Peripheral Vascular Diseases; Prognosis; Risk Factors

Topics: Catheterization, Central Venous; Constriction, Pathologic; Drug-Related Side Effects and Adverse Reactions; Fibrin; Humans; Peripheral Vascular Diseases; Prognosis; Vena Cava, Superior; Venous Thrombosis

Patients with peripheral arterial disease have a high risk of death from cardiovascular events. As defective fibrinolysis associated with leg atherosclerosis has been suggested as a predisposing factor, we sought a relation among decreased fibrinolysis, the presence of leg atherosclerosis and the incidence of thrombotic events in a case-control study nested in the PLAT. Fifty-eight patients with coronary and/or cerebral atherothrombotic disease, free of leg atherosclerosis at Doppler examination, were compared with 50 atherosclerotic patients with leg involvement. High D-dimer (153.0 vs 81.3 ng/ml, p < 0.001) and tPA antigen before venous stasis (14.4 vs 11.8 ng/ml, p < 0.03), and low tPA antigen (6.7 vs 15.6 ng/ml, p < 0.01) and fibrinolytic activity released after venous stasis (fibrinolytic capacity: 113.2 vs 281.4 mm2, p < 0.001) were found in patients with leg atherosclerosis. D-dimer and fibrinolytic capacity, in addition to age, were selected by stepwise discriminant analysis as characterizing patients with leg atherosclerosis. Moreover, higher D-dimer and tPA inhibitor characterized patients with leg atherosclerosis who subsequently experienced thrombotic events. These findings constitute evidence of high fibrin turnover and impaired fibrinolytic potential in patients with leg atherosclerosis. Thus impaired fibrinolysis may contribute to the prothrombotic state in these patients.

Topics: Aged; Arteriosclerosis; Blood Glucose; Blood Pressure; Blood Proteins; Case-Control Studies; Disease Susceptibility; Fibrin; Fibrinolysis; Humans; Leg; Lipids; Male; Middle Aged; Peripheral Vascular Diseases; Prospective Studies; Risk Factors; Smoking; Thrombophlebitis

Fifteen patients (9 male, 6 female) undergoing peripheral vascular surgery were monitored during surgery for evidence of subclinical anticoagulation using the activated coagulation time (ACT), thromboelastography (TEG), and heparin titration monitoring. Assessments were made at 30-minute intervals before and after the occlusion clamp. Mean (+/- SD) ACT values preoperatively were 111 (17) seconds, and 10 minutes after 5,000 IU of heparin, the ACT was 264 (57) seconds (P < 0.001). Intraoperatively, there was a significant decline in ACT values at 30 minutes (ACT 228 [50] sec, P < 0.005) and 60 minutes (200 [46] sec, P < 0.001) postheparin. No significant difference in ACT was observed between samples drawn distally and proximally to the clamp. TEG profiles were abolished in all patients immediately following heparinization. However, in 2 patients nearly complete return of the TEG coagulation profile was observed prior to the termination of the procedure and was associated with ACT values less than 160 seconds. The heparin device was unable to accurately monitor heparin elimination at these low doses. Variability of patient response to heparinization necessitates the use of intraoperative monitoring of anticoagulation during peripheral vascular surgery.

Topics: Aged; Aged, 80 and over; Aortic Diseases; Arterial Occlusive Diseases; Blood Coagulation; Blood Vessel Prosthesis; Female; Femoral Artery; Fibrin; Heparin; Humans; Iliac Artery; Male; Middle Aged; Monitoring, Intraoperative; Peripheral Vascular Diseases; Thrombelastography; Titrimetry; Whole Blood Coagulation Time

Immunohistochemical studies of human atherosclerotic lesions have demonstrated the occurrence of fibrin deposition and its degradation in the arterial wall. We studied fibrinogen, the generation of thrombin, and the degradation of fibrin in 40 patients with stable peripheral arterial occlusive disease of varying severity, as assessed by the ankle/brachial pressure index and duplex ultrasonography and/or angiography. Circulating fibrinogen (functional and immunological), fibrinopeptide A, thrombin-antithrombin III complex, and D-dimer were measured. The severity of atherosclerosis was associated with both fibrinogen (both functional and immunological) and D-dimer (r = .57, P < .0002, and r = .57, P < .0001, respectively). Fibrinogen and D-dimer showed a significant positive correlation (r = .50, P < .001). Generation of thrombin was detected in 24 patients (60%) by fibrinopeptide A and levels of thrombin-antithrombin III complex. As a sign of coagulation activation and fibrinolysis, we found that thrombin-antithrombin III complex and the degradation of cross-linked fibrin were progressively associated with the extent of vascular disease. The plasmin-mediated fibrin breakdown contributed to increased levels of circulating fibrinogen, an established risk factor for thrombotic complications. The significant correlations between fibrinogen/D-dimer and the severity of atherosclerosis support previous pathological studies and imply that local degradation of cross-linked fibrin is involved in the progression of atherosclerosis.

Topics: Adult; Aged; Aged, 80 and over; Antithrombin III; Arteriosclerosis; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Fibrinopeptide A; Humans; Male; Middle Aged; Peptide Hydrolases; Peripheral Vascular Diseases; Radiography; Ultrasonography

A radioimmunoassay (RIA) has been set up using purified human melanoma tissue plasminogen activator and a specific antiserum raised against it. Concentration of antigen in citrated plasma of resting human subjects was found to be 7.1 +/- 1.6 ng/ml (mean +/- S.D.) while the lower limit of sensitivity of the RIA was 2 ng/ml. After venous occlusion or DDAVP infusion the levels of antigen were invariably elevated and a significant increase in the proportion of antigen having fibrin binding properties was observed. Decay studies in vitro and gel filtration of post-stimulus plasma indicated that the RIA detects active and inactive forms of antigen and the possible nature of the inactive antigen is discussed.

Topics: Arm; Chromatography, Gel; Constriction, Pathologic; Deamino Arginine Vasopressin; Fibrin; Fibrinolysis; Hemostatics; Humans; Infusions, Parenteral; Male; Peripheral Vascular Diseases; Radioimmunoassay; Reproducibility of Results; Tissue Plasminogen Activator

Topics: Fibrin; Humans; Peripheral Vascular Diseases; Skin; Vascular Diseases; Vasculitis

Topics: Animals; Arteriovenous Anastomosis; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Fibrin; Peripheral Vascular Diseases; Rabbits; Renal Dialysis; Vascular Diseases

Topics: Arterial Occlusive Diseases; Fibrin; Fibrinogen; Humans; Peripheral Vascular Diseases; Vascular Diseases