Fibrinogen Predicts Restenosis after Endovascular Treatment of the Iliac Arteries

Martin Schillinger; Markus Exner; Wolfgang Mlekusch; Helmut Rumpold; Ramazanali Ahmadi; Schila Sabeti; Oswald Wagner; Erich Minar

doi:10.1055/s-0037-1613118

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2002; 87(06): 959-965
DOI: 10.1055/s-0037-1613118

Review Article

Schattauer GmbH

Fibrinogen Predicts Restenosis after Endovascular Treatment of the Iliac Arteries

Authors

Martin Schillinger

¹Department of Angiology, University of Vienna, Medical Faculty, Vienna, Austria
Markus Exner

²Department of Laboratory Medicine, University of Vienna, Medical Faculty, Vienna, Austria
Wolfgang Mlekusch

²Department of Laboratory Medicine, University of Vienna, Medical Faculty, Vienna, Austria
Helmut Rumpold

²Department of Laboratory Medicine, University of Vienna, Medical Faculty, Vienna, Austria
Ramazanali Ahmadi

¹Department of Angiology, University of Vienna, Medical Faculty, Vienna, Austria
Schila Sabeti

¹Department of Angiology, University of Vienna, Medical Faculty, Vienna, Austria
Oswald Wagner

²Department of Laboratory Medicine, University of Vienna, Medical Faculty, Vienna, Austria
Erich Minar

¹Department of Angiology, University of Vienna, Medical Faculty, Vienna, Austria

Abstract

Summary

Objective

Fibrinogen is an acute phase protein as well as a component of the coagulation cascade. Vascular inflammation and disturbed coagulation are suggested to cause restenosis after percutaneous transluminal angioplasty (PTA). We investigated the prognostic impact of fibrinogen on restenosis after endovascular treatment of iliac artery occlusive disease.

Methods

In a prospective cohort study 137 consecutive patients after iliac artery PTA (n = 74) and PTA plus selective stent implantation (n = 63) were included, 109 patients after lower limb angiography served as a control group. Patients were followed for 6 months with oscillography, ankle brachial index and duplex sonography for occurrence of restenosis. Fibrinogen and serum amyloid A (SAA), as a control parameter of inflammation, were obtained at baseline, 8, 24 and 48 h postintervention.

Results

PTA (adjusted OR 3.1, p = 0.05) and stenting (adjusted OR 13.3, p = 0.001) were independently associated with a higher postintervention increase of fibrinogen compared to angiography. Restenosis was found in 29 patients (21%). Patients with pre-intervention fibrinogen values in the third quartile (411-463 mg/dl) had a 6.2-fold increased adjusted risk for restenosis (p = 0.03), patients in the fourth quartile (> 463 mg/dl) had a 8.9-fold increased adjusted risk (p = 0.007). Pre-intervention SAA values were also significantly associated with restenosis (p < 0.0001). Postintervention fibrinogen and SAA levels showed no association with outcome.

Conclusion

Balloon angioplasty and stenting of the iliac arteries cause an elevation of postintervention fibrinogen levels independently of angiographic factors. A higher pre-procedure fibrinogen level, presumably a marker of inflammatory activity, indicates a higher risk for restenosis.

Keywords

Fibrinogen - inflammation - iliac - restenosis

Volltext

Referenzen

References
1 Beattie GC, Brittenden J, Gillespie I, McBride K, McInnes G, Bradbury AW. Vascular surgical society of Great Britain and Ireland: outcome of iliac percuteanous transluminal angioplasty with and without the use of stents in patients with intermittent claudication. Br J Surg 1999; 86: 704-5.
2 Bosch JL, Tetteroo E, Mali WP, Hunink MG. Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty Dutch Iliac Stent Trial Study Group. Radiology 1998; 208: 641-8.
3 Treiman GS, Schneider PA, Lawrence PF, Pevec WC, Bush RL, Ichikawa L. Does stent placement improve the results of ineffective or complicated iliac artery angioplasty?. J Vasc Surg 1998; 28: 104-2.
4 Tetteroo E, van der Graaf Y, Bosch JL, van Engelen AD, Hunink MG, Eikelboom BC, Mali WP. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease Dutch Iliac Stent Trial Study Group. Lancet 1998; 351: 1153-9.
5 Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology 1997; 204: 87-96.
6 Sullivan TM, Childs MB, Bacharach JM, Gray BH, Piedmonte MR. Percutaneous transluminal angioplasty and primary stenting of iliac arteries in 288 patients. J Vasc Surg 1997; 25: 829-38.
7 Johnston KW. Iliac arteries: reanalysis of results of balloon angioplasty. Radiology 1993; 186: 207-12.
8 Forrester JS, Fishbein M, Helfant R. et al. A paradigm for restenosis based on cell biological clues for the development of new preventive therapies. J Am Coll Cardiol 1991; 17: 758-69.
9 Serrano CV, Ramires JA, Venturinelli M. et al. Coronary angioplasty results in leucocyte and platelet activation with adhesion molucule expression Evidence of inflammatory responses in coronary angioplasty. J Am Coll Cardiol 1997; 29: 1276-83.
10 Kornowski R, Hong MK, Tio FO. et al. In-stent restenosis: contributions of inflammatory responses and arterial injury to neointimal hyperplasia. J Am Coll Cardiol 1998; 31: 224-30.
11 Yutani C, Ishibashi-Ueda H, Suzuki T. et al. Histologic evidence of foreign body granulation tissue and de novo lesions in patients with coronary stent stenosis. Cardiology 1999; 92: 171-7.
12 Virmani R, Farb A. Pathology of in-stent restenosis. Curr Opin Lipidol 1999; 10: 499-506.
13 Thompson WD, Smith EB, Stirk CM, Kocchar A. Atherosclerotic plaque growth: presence of stimulatory fibrin degradation products. Blood Coagul Fibrinolysis 1990; 01: 489-93.
14 Thompson WD, Harvey JA, Kazmi MA, Stout AJ. Fibrinolysis and angiogenesis in wound healing. J Pathol 1991; 165: 311-8.
15 Dormandy JA, Rutherford B. Management of peripheral arterial disease (PAD) TASC Working Group TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31: S1-S296.
16 Schillinger M, Haumer M, Schlerka G. et al. Restenosis after percutaneous transluminal angioplasty in patients with peripheral artery disease: the role of inflammation. J Endovasc Ther 2001; 08: 477-83.
17 Minar E, Pokrajac B, Ahmadi R. et al. Brachytherapy for prophylaxis of restenosis after long-segment femoropopliteal angioplasty: pilot study. Radiology 1998; 208: 173-9.
18 Exner M, Schillinger M, Minar E. et al. Heme oxygenase-1 microsatellite gene promoter polymorphism is associated with restenosis after percutaneous transluminal angioplasty. J Endovasc Ther 2001; 08: 433-40.
19 Ranke C, Creutzig A, Alexander K. Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. Ultrasound Med Biol 1992; 18: 433-40.
20 Tetteroo E, van Engelen AD, Spithoven JH, Tielbeek AV, van der Graaf Y, Mali WP. Stent placement after iliac angioplasty: comparison of hemodynamic and angiographic data Dutch Iliac Stent Trial Study Group. Radiology 1996; 201: 155-9.
21 Hosmer DW, Lemeshow S. (eds.) Applied logistic regression. 1st edition. John Wiley & Sons; New York: 1989: 135-75.
22 Schillinger M, Exner M, Mlekusch W, Haumer M, Ahmadi R, Rumpold H, Wagner O, Minar E. Balloon angioplasty and stent implantation induce a vascular inflammatory reaction. J Endovasc Ther 2002; 09: 59-66.
23 Roller RE, Janisch S, Carroll V, Kvas E, Pilger E, Binder BR, Wojta J. Changes in the fibrinolytic system in patients with peripheral arterial occlusive disease undergoing percutaneous transluminal angioplasty. Thromb Res 1999; 94: 241-7.
24 Woodburn KR, Lowe GD, Pollock JG, Rumley A, Reid AW. Percutaneous angioplasty, endothelial markers and fibrin turnover. J Endovasc Surg 1994; 01: 53-60.
25 Tschopl M, Tsakiris DA, Marbet GA, Labs KH, Jager K. Role of hemostatic risk factors for restenosis in peripheral arterial occlusive disease after transluminal angioplasty. Arterioscler Thromb Vasc Biol 1997; 17: 3208-14.
26 Tsakiris DA, Tschopl M, Wolf F, Labs KH, Jager KA, Marbet GA. Platelets and cytokines in concert with endothelial activation in patients with peripheral arterial occlusive disease. Blood Coagul Fibrinolysis 2001; 11: 165-73.
27 Marguerie G, Ginsberg MH, Plow EF. The role of fibrinogen in platelet aggregation. In: Fibrinogen-fibrin formation and fibrinolysis. Lane DA, Henschen A, Jasani MK. (eds.) 1986. 04 175-83.
28 Dejana E, Languino LR. Interaction of platelets and leukocytes with endothelial cells. In: Blood vessel wall and thrombosis. Marvich R. 1988. 01 197-206.
29 Ernst E. Fibrinogen An independent risk factor for cardiovascular disease. BMJ 1991; 303: 596-7.
30 van Lankeren W, Gussenhoven EJ, van der Lugt A, Vischjager M, Khaje P, Pieterman H, Gerritsen PG. Intravascular sonographic evaluation of iliac-artery angioplasty: what is the mechanism of angioplasty and can intravascular sonography predict clinical outcome?. Am J Roentgenol 1996; 166: 1355-60.
31 Tetteroo E, Haaring C, van der Graaf Y, van Schaik JP, van Engelen AD, Mali WP. Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions Dutch Iliac Stent Trial Study Group. Cardiovasc Intervent Radiol 1996; 19: 411-7.