| 1. |
- Blomstrand, David, et al.
(författare)
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Activated Protein C-Protein C Inhibitor Complex in Peripheral Arterial Disease.
- 2010
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Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 1615-5947 .- 0890-5096. ; May 4, s. 588-595
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Thrombin activation measured by the levels of the complex between activated protein C (APC) and the protein C inhibitor (PCI) is elevated in several atherosclerotic disorders. The aim of this study was to evaluate whether levels of the APC-PCI complex are related to the prognosis in peripheral arterial disease (PAD). Longitudinal study performed at the Vascular Centre, Malmö University Hospital, Sweden. METHODS: APC-PCI complex levels were analyzed in 268 consecutive patients hospitalized for PAD and in 42 healthy controls (median age, 74 years). Patients (n = 35) with warfarin treatment less than 4 weeks before APC-PCI sampling were excluded from analysis. Data-based medical records of all 233 remaining patients (median age, 72 [64-79] years) were searched for vascular events such as hospitalization because of atherosclerotic disease, operative or endovascular recanalization of peripheral arteries, transtibial or transfemoral amputation because of PAD, acute coronary syndrome, stroke, or death. RESULTS: Median duration of follow-up was 16 months (interquartile range, 12-23 months). APC-PCI complex levels were higher in PAD patients than in controls (0.240 [0.180-0.320] mug/L vs. 0.140 [0.190-0.220] mug/L; p < 0.0001) but not associated with an increased risk for death (p = 0.2054) or events during follow-up (p = 0.2850). Independent predictors of future events were low b-hemoglobin (p = 0.0084), high b-leukocytes (p = 0.0034), and history of a previous vascular event (p = 0.0032). Age (p = 0.0286), high p-creatinine (p = 0.0165), and history of a previous event (p = 0.0311) were independent predictors of death. CONCLUSION: APC-PCI complex levels were higher in PAD patients than in controls, but did not predict the clinical outcome. The effect of a possible prethrombotic state, as reflected in increased APC-PCI levels, on prognosis and severity of atherosclerotic disease has to be further investigated.
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| 2. |
- Flondell-Sité, Despina, et al.
(författare)
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Cytokines and systemic biomarkers are related to the size of abdominal aortic aneurysms.
- 2009
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Ingår i: Cytokine. - : Elsevier BV. - 1096-0023 .- 1043-4666. ; 46, s. 211-215
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The etiology of abdominal aortic aneurysm (AAA) includes atherosclerotic, inflammatory, immunological and coagulatory mechanisms. The aim of this study was to evaluate associations between markers for some of these mechanisms and AAA-size, in order to identify markers which might later be evaluated in relation to aneurysm growth. Material and methods: Prospectively 360 AAA-patients and an age and sex-matched healthy control group (n=219) were analyzed. AAA-patients were divided in three groups according to AAA-diameter (small <45mm, n=122, medium 45-55mm, n=108, and large >55mm, n=130). Associated diseases, blood pressures and routine laboratory markers were analyzed. Additionally we evaluated endothelin (ET)-1, tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, activated protein C-protein C inhibitor (APC-PCI) complex, and CD40 ligand. Groups were compared with the Kruskall-Wallis test and the Mann-Whitney U test. Results: Of routine markers platelet count was lower (p=0.0006) and creatinine level was higher (p=0.028) in patients with large AAA. Almost all non-routine markers analyzed were highly elevated in AAA-patients compared to the control group. IL-6 (p=0.0002) and thrombin activation measured as APC-PCI (p<0.0001) increased depending on the size of AAA. Conclusion: Many of the analyzed biomarkers were markedly increased in AAA-patients and some were also related to aneurysm size. Whether any of the markers is also associated with aneurysm growth rate should be further evaluated.
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| 3. |
- Flondell-Sité, Despina, et al.
(författare)
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Markers of proteolysis, fibrinolysis, and coagulation in relation to size and growth rate of abdominal aortic aneurysms.
- 2010
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Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 44:4, s. 262-268
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Tidskriftsartikel (refereegranskat)abstract
- We evaluated whether matrix metalloproteinases (MMPs) 2 and 9, their inhibitors, markers for fibrinolysis, and thrombin activation are associated with diameter and growth of abdominal aortic aneurysms (AAAs). Material and Methods: Matrix metalloproteinases 2 and 9, tissue inhibitor of MMPs (TIMP-1), serpine-1, tPa-serpine-1, and activated protein C- protein C inhibitor (APC-PCI) complex were analyzed in 353 patients with AAA grouped according to AAA size, and 219 gender- and age-matched healthy individuals. Follow-up of AAA growth for up to 7 years was possible in 178 of 353 patients. Results: At baseline, all groups of patients with AAA showed lower levels of MMP-2 and -9, and higher levels of TIMP-1, serpine-1, and t-Pa-serpine-1 than controls. Matrix metalloproteinase 2 correlated inversely and APC-PCI complex correlated directly with AAA diameter. We found no correlations between markers for proteolysis, fibrinolysis, coagulation, and yearly AAA growth. CONCLUSION: Matrix metalloproteinase 2 is lower and APC-PCI higher in patients with larger AAA, but the relevance of the markers for AAA growth is far from clarified.
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| 4. |
- Gottsäter, Anders, et al.
(författare)
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Associations Between Statin Treatment and Markers of Inflammation, Vasoconstriction, and Coagulation in Patients With Abdominal Aortic Aneurysm
- 2008
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Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 42:6, s. 567-573
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Tidskriftsartikel (refereegranskat)abstract
- The association of statins with markers of inflammation, vasoconstriction, and coagulation was evaluated in 325 patients with abdominal aortic aneurysm with respect to statin treatment or not. Variables evaluated included routine laboratory markers, lipids, homocysteine, endothelin-1, matrix metalloproteinases (MMP)-2 and -9, and activated protein C-protein C inhibitor (APC-PCI) complex. Statin-treated patients were more often male (85% vs 75%; P = .024) and had ischemic heart disease (57% vs 19%; P < .0001). They showed lower levels of cholesterol (P < .0001), homocysteine (P = .027), MMP-9 (P = .038), and endothelin-1 (P = .005), and higher levels of APC-PCI complex (P = .042). Differences persisted in logistic regression for cholesterol (P < .0001), APC-PCI complex (P = .034), and homocysteine (P = .021). Statin-treated patients with abdominal aortic aneurysm show higher APC-PCI complex and lower homocysteine levels. Whether this translates into lower risk for aneurysm expansion or rupture will be evident from further follow-up.
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| 5. |
- Kölbel, Tilo, et al.
(författare)
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Activated protein C-protein C inhibitor complex: a new biological marker for aortic aneurysms.
- 2006
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 43:5, s. 935-939
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The concentration of the complex between activated protein C (APC) and protein C inhibitor (PCI) is a measure of thrombin generation. We studied whether it can provide information useful for the diagnosis and treatment of arterial vascular disease. Methods: Blood was obtained from 429 vascular patients admitted consecutively during September 2004 to March 2005. The APC-PCI complex was measured by using a sandwich immunofluorometric method. The patients were divided into cohorts according to the planned treatment and compared with a control group of healthy individuals. Results: The APC-PCI complex concentration varied from 0.08 to 2.50 mu g/L. In the cohort of patients with aortic aneurysms (n = 78), the median APC-PCI value was 0.45 (10(th) to 90(th) percentile, 0.24-1.47), and values were clearly increased compared with all other cohorts (P <.0001). Patients with carotid disease (n = 73) yielded a median of 0.22 (10(th) to 90(th) percentile, 0.15-0.48). The median for claudicants (n = 74) was 0.26 mu g/L (10(th) to 90(th) percentile, 0.15-0.75), which was higher than in those (n = 97) with critical ischemia (0.20; 10(th) to 90(th) percentile, 0.13-0.36; P <.0023). The cohort with other forms of antherosclerotic disease (n = 40) had a median of 0.23 (10(th) to 90(th) percentile, 0.14-0.42), whereas the value for a cohort of 21 patients with venous disease was 0.19 (10(th) to 90(th) percentile, 0.10-0.34). The median was 0.15 (10(th) to 90(th) percentile, 0.10-0.23) for the control group (n = 121). Conclusions: Patients with atherosclerosis had an increased APC-PCI concentration that corresponded to increased generation of thrombin. Patients with aortic aneurysm had a threefold higher median concentration than the control group. We suggest that this remarkable increase is caused by the local activation of coagulation, and we surmise that APC-PCI measurements can be used as a screening tool to identify patients with aortic aneurysms.
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| 6. |
- Kölbel, Tilo, et al.
(författare)
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Activated Protein C Protein C Inhibitor Complex in Patients With Abdominal Aortic Aneurysms: Is It Associated With Diameter and Growth Rate?
- 2008
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Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 42:2, s. 135-140
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Tidskriftsartikel (refereegranskat)abstract
- Increased thrombin activation has been documented in patients with abdominal aortic aneurysm (AAA). APC-PCI complex, a new biological marker of thrombin generation, was measured in a population of 232 patients with AAA relative and a control group and the association between aneurysm size, growth rate and APC-PCI was studied. The patients were divided into cohorts according to the AAA diameter and compared with a control group. APC-PCI was significantly higher in all AAA-cohorts (n = 232; median: 0.36 mg/L; 10th - 90th percentile: 0.18-1.01) compared to the control group (n = 41; median: 0.19 mg/L; 10th - 90th percentile: 0.11-0.31; P = <0.001). APC-PCI correlated with the AAA diameter (r = 0.22, P = 0.001), with the BMI (r = -0.19, P = 0.004) and with age (r = 0.19, P = 0.004). APC-PCI did not correlate with the AAA-growth rate (r = 0.11, P = 0.14).
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| 7. |
- Kölbel, Tilo, et al.
(författare)
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Catheter-directed foam sclerotherapy of axial saphenous reflux: early results
- 2007
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Ingår i: Phlebology. - : SAGE Publications. - 1758-1125. ; 22:5, s. 219-222
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Foam sclerotherapy of the great saphenous vein is a relatively new and promising treatment option for patients with axial reflux. Its usefulness may be limited by low primary occlusion rates. We present a standard technique for catheter-directed foam sclerotherapy, which facilitates foam delivery precisely to its intended site of action and potentially improves occlusion rates. Methods: A consecutive series of 53 patients were treated with foam sclerotherapy using a standard technique for foam delivery at Malmo University Hospital between September 2006 and April 2007. Patients were treated with 3% polidocanol foam through an introducer sheath, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV) All successfully treated patients were examined by colour duplex one week after the procedure. Results: Primary technical success with delivery of foam along the length of the GSV was achieved in 50 of 53 limbs (94%). All treated GSVs were occluded at one week duplex. Conclusion: The use of an enclovascular sheath inserted percutaneously over a guidewire under duplex ultrasound control is feasible in most patients and has resulted in high primary occlusion rates.
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| 8. |
- Kölbel, Tilo, et al.
(författare)
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Is Increased Thrombin Activation in Patients With Abdominal Aortic Aneurysms Dependent on Area or Volume of Aneurysm Thrombus Mass?
- 2010
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Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 61:1, s. 113-118
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Does thrombin activation seen in patients with abdominal aortic aneurysms (AAA) relate to the thrombus surface area or volume within the aneurysm? Patients and methods: A total of 130 patients with AAA were analyzed regarding levels of the complex between activated protein C-protein C inhibitor (APC-PCI) and AAA morphology. Analysis of APC-PCI complex was made using a sandwich immunofluorometric method. Results: Increased APC-PCI concentrations were seen in patients with AAA (0.44 mu g/L; P < .001 compared with controls). The correlations of APC-PCI values were r = .13, P = .13 for aneurysm size, r = .08, P = .35 for thrombus surface area, and r = .13, P = .14 for thrombus volume. APC-PCI values elevated to 0.45 mu g/L in 10 patients with AAA having no or very little thrombus mass. Conclusion: Disappointingly, no correlation was found between thrombus surface area or volume and levels of the APC-PCI complex. Mechanisms other than the AAA-sac thrombus must be evaluated as cause of thrombin activation in patients with AAA.
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| 9. |
- Lindblad, Bengt, et al.
(författare)
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What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae.
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:2, s. 165-173
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Tidskriftsartikel (refereegranskat)abstract
- Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available. MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment. RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended. CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.
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| 10. |
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