Leptin and leptin receptor evaluation in atherosclerotic plaques in patients with type 2 diabetes mellitus

Background. Diabetes mellitus (DM) is a significant predictor of atherosclerosis, cardiovascular disease, and cardiovascular mortality. It is known that atherosclerosis occurs earlier in patients with diabetes, reducing the duration of their life. Leptin as well as other inflammatory markers can contribute to the progression of atherosclerosis in patients with DM, participate in the development of a local inflammatory reaction. Aim. Determine the cells immunophenotype of atherosclerotic plaques in patients with diabetes. Materials and methods. We analyzed 24 patients (20 men and 4 women), who underwent aortofemoral bypass, femoral-tibial bypass or carotid endarterectomy. During the operation, a fragment of the arterial wall with an atherosclerotic plaque was obtained for further immunohistochemical studies. Five histologic plaque characteristics (CD68+, -SMA, CD34, leptin and leptin receptor) were compared. Results. No difference in the expression of CD68 (p=0.922), -SMA (p=0.192), CD34 (p=0.858), leptin receptor (p=0.741) and leptin (p=0.610) in atherosclerotic plaques were observed between patients with and without DM. The lack of significant differences between the two groups was possibly due to the small number of observations with DM. In particular, when assessing the expression of selected markers in atherosclerotic plaques, patients with DM showed significantly more leptin receptors than patients without DM (2160.716 and 1205.88 respectively); and also significantly less CD68+ (0.39 and 0.98 respectively) and -SMA+ (6.5 and 13.5 respectively). Conclusion. Based on the expression of CD68, -SMA, CD34, leptin receptor and leptin, no significant differences were observed in atherosclerotic plaque between patients with and without DM. At the same time, despite the limitations of the study (a small number of patients, moderate severity of DM, elderly patients in the DM group), we found a tendency in the increased number of leptin receptors and a decreased number of -SMA+, CD68+ in DM atherosclerotic plaques. Further study needed, taking into account the limitations of this work.

Aorto Femoral Bypass Graft in Chronic Limb Ischemia Patient

A 44-year-old man was admitted to hospital to be performed re-thrombectomy after previously performed thrombectomy at the referring hospital but did not show clinical improvement. CT angiography results before re-thrombectomy showed a central thrombus measuring 1.1 cm in diameter, and an impression of 2.6 cm long at the branching of the right external Iliaca artery which caused total obstruction of the right illiaca external artery to the distal. Aortofemoral bypass graft surgery is a procedure utilized commonly for the treatment of aortoiliac occlusive disease. The treatment given to manage symptoms if medical management or minimally invasive therapy, such as balloon angioplasty and stenting, was unsuccessful or unsuitable for the patient. Aortofemoral bypass graft surgical procedure was performed on the patient. However, post procedure angiography showed no visible flow through the newly placed graft. A repair graft procedure was planned for the patient, but the patient refused to undergo further surgical procedures.

The PRESENTATION AND OUTCOMES OF AORTOFEMORAL BYPASS SURGERY IN PATIENTS WITH AORTOILIAC OCCLUSIVE DISEASE. FOUR YEARS’ EXPERIENCE AT A TERTIARY CARE HOSPITAL

Objective: To highlight the presentation and outcomes of Aortofemoral bypass surgery at a tertiary care hospital. Study Design: Prospective observational study. Place and Duration of Study: Vascular Surgery department, Combined Military Hospital Lahore, from Jan 2015to Dec 2019. Methodology: A total of 23 patients between 50-80 years of age presenting with critical limb ischemia due toAortoiliac occlusive arterial disease type C or D of Trans-Atlantic inter Society Consensus (TASC) II classificationconfirmed on CT Angiogram, were included in the study. The clinical presentation, co-morbid illnesses, historyof smoking, obesity, post operative patency of graft, wound infection, amputation rates, and mortality weredocumented on a structured proforma. All patients were followed up at 1, 6, 12 and 24 months of surgery.Outcomes were assessed in terms of graft patency, wound infection, limb survival, amputations and mortality.Data was analyzed by SPSS version 23.0. Results: The mean age of patients was 71.04 ± 7.29 years. Most patients presented with rest pain (56.5%). Thefrequency of smokers was 78.3% while 34.8% patients had both diabetes mellitus and ischemic heart disease.Hyperlipidemia was present in 30.4% patients. Two patients (8.7%) developed superficial surgical site infection.The limb salvage rate was 95.7% and the mortality rate was 4.3%. Conclusion: Aortofemoral bypass surgery is a safe and highly effective treatment modality for the management of aortoiliac occlusive arterial disease in experienced hands. Limb salvage can be successfully achieved in more than 95% cases.Keywords: ,, ,, .