The expression profile of angiogenic genes in critical limb ischemia popliteal arteries.

Critical limb ischemia (CLI) represents the most severe form of peripheral arterial disease (PAD) and is the leading cause of non-traumatic amputations in western populations. In recent years, therapeutic angiogenesis has been considered to be a potential treatment option for CLI patients, however the molecular mechanism of ischemia-induced vascularization is still not fully understood. The identification of genetic factors underlying vascular responses to ischemia will improve our understanding of the biological causes of the disease and enhance personalized therapies in the future. In this work, we determined, for the first time, the expression profile of angiogenesis-related genes utilizing unique human material: the popliteal arteries retrieved during lower limb amputation from patients with CLI. Using custom-designed TaqMan Low-Density Array (TLDA) cards we investigated the mRNA level of 90 genes on CLI samples compared to healthy donors. We identified three significantly up-regulated genes in CLI group: matrix metalloproteinase 9 (MMP-9), VE-cadherin (CDH5) and integrin alpha 4 (ITGA4). However, among all investigated genes, only lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) was significantly reduced. In order to verify whether hypoxic conditions occur in popliteal arteries of CLI patients, we validated the transcription level of selected proangiogenic genes by real-time PCR on a larger number of samples. These results showed that the expression of key genes involved in angiogenesis, such as MMP9, HGF, HIF1A, VEGF-A and FLT1 were elevated in patients with CLI. Moreover, the study revealed that the expression of VEGF-A and FLT1 was associated with activation of HIF1A transcription. In conclusion, our data revealed the alteration in the mRNA level of genes involved in matrix remodelling, cell-cell adhesion as well as endothelial cell migration and proliferation in human popliteal arteries.

Elevated expression of runt-related transcription factors in human abdominal aortic aneurysm.

Abdominal aortic aneurysm (AAA) is a multifactorial disease of unknown etiology. AAA is caused by segmental weakening of the aortic walls and progressive aortic dilation leading to the eventual rupture of the aorta, accompanied by intense inflammation. Additionally, studies have indicated a close relationship between the pathogenesis and progression of AAA and cellular immune responses in aneurysm wall tissue. The Runt-related genes (RUNX) encode multifunctional mediators of the of intracellular signal transduction pathways in vascular remodeling, endothelial function, immune response and inflammation. The aim of this study was to evaluate the expression level of RUNX regulatory genes in AAA tissues and to assess the correlations between them. The study was performed on AAA wall-tissue samples obtained from patients with AAA during open aneurysm repair and normal aortic tissues collected from healthy organ donors. There are no proven clinical management strategies or pharmaco-therapeutics to prevent AAA progression once an AAA has been detected. Moreover, so far no biomarkers have been established to indicate the disease status of AAA. Hence, understanding the pathogenesis of AAA has recently become an increasing priority in basic and translational vascular research. We identified significantly higher mRNA and protein level of all of three Runt-related genes in aneurysmal aorta compared to a normal aorta. Increased expression of RUNX2 was demonstrated for the first time in abdominal aortic aneurysm tissue. Additionally, relationships between the activity of RUNX genes in the pathological tissue were identified. The results of elevated expression of RUNX genes and their relationships in the AAA tissues suggest the involvement of conserved Runt-related genes in the pathophysiology of AAA development.

Iatrogenic injuries of the carotid arteries.

BACKGROUND: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. PATIENTS AND METHODS: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. RESULTS: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. CONCLUSIONS: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.

[Examination of elastase concentration in the wall of abdominal aortic aneurysms]. / Badania poziomu elastazy w scianie tetniaków aorty brzusznej.

Authors examined concentration of the leukocyte elastase (LE) in serum and walls of atherosclerotic abdominal aorta, ruptured and nonruptured aneurysms of abdominal aorta. Control group included LE level in normal abdominal aortas from multi organ donors. For trial 12589 PMN ELASTASE (2th Version) MERCK IMMUNOASSAY was using. From November of 1994 to December 1997 87 patients were explorated. Our study presents highest level of the LE in sequence: ruptured aneurysms, nonruptured aneurysms, atherosclerotic aortas and normal aortas. We did not confirm any statistic dependence between serum LE levels. Analysis between aneurysms diameter and their LE level, evaluated mutual dependence. Exploration proved connection between expansion and inflammatory genesis of atherosclerosis disease (activity of the PMN-elastasis in vessels wall).

[The management in vascular trauma of extremities]. / Postepowanie w urazach naczyniowych konczyn.

Between 1990-1998 in the Department of Vascular Surgery, Medical Academy in Wroclaw, 104 patients were operated due to artery trauma: 28 women, 76 men. Mean age was 37 years. In 58 cases acute ischaemia occurred, in 46--haemorrhage. Preoperative procedure consisted of preparation and diagnostics, in some cases angiography. Predominantly autogenous material was used for artery reconstruction. In 25 cases prosthetic grafts were implanted. In 53 patients (79.1%) good results were obtained, complications occurred in 14 cases (20.9%).

[Erection disorders after implantation of aorto-bifemoral prosthesis]. / Zaburzenia erekcji po wszczepieniu protezy aortalno-dwuudowej.

In this paper we present sexual complications occurring after implantation of vascular aorto-bifemoral prosthesis. We have sent an inquiry to 1236 men, who were operated in Vascular Department of Medical Academy in Wroclaw in years 1983-1997. We received 659 answers. Additionally 302 patients were examined. We noticed disorders of erection after vascular operation in 350 cases. In 29 cases erection reappeared after operation. Only 112 patients declared correct ejaculation and 137 men have satisfied sexual life. This results present problem of postoperative ischaemia of minor pelvis and trauma to neural plexus of bifurcation of aorta. In cases of younger sexually active men, who need revascularisation of lower extremities by implantation of vascular aortobifemoral prosthesis we suggest endarterectomy of hypogastric artery and/or implantation this artery to prosthesis.

[Clinical evaluation of a polyester vascular prosthesis impregnated with albumins from material of the Vascular Surgical Clinic AM in Wroclaw in the years 1994-1997. Introductory report]. / Ocena kliniczna poliestrowej impregnowanej albuminami protezy naczyniowej w materiale Kliniki Chirurgii Naczyniowej AM we Wroclawiu w latach 1994-1997. Doniesienie wstepne.

The aim of this work was clinical evaluation of impregnated (albumins) prostheses of Polish production. Those prostheses were compared with polyester knitted vascular prostheses. We evaluated a group of 48 patients to whom prostheses covered with albumins were implanted and 52 patients to whom nonimpregnated prosthesis was implanted in 1994-1997. The prostheses were implanted in aortofemoral segment. The achieved results prove the good quality of the impregnated prosthesis and its high value for vascular reconstructive surgery.