Influence of Combined Antioxidant Therapy on Results of Endovascular Treatment of Patients with Peripheral Arterial Disease

INTRODUCTION: The number of endovascular interventions performed on the arteries of the lower extremities is growing annually in the world, as they provide faster patient recovery and shorten the period of hospital stay. However, the development of restenosis of the reconstruction zone often leads to a need for repeated operations. AIM: To evaluate the effectiveness of combined antioxidant therapy in reducing the risk of restenosis after endovascular interventions. MATERIALS AND METHODS: The study included 84 patients with IIB–III stage peripheral arterial disease (PAD). Group A included 45 patients who underwent endovascular interventions, group B included 39 patients who were prescribed combined antioxidant therapy (Vitamin E, Actovegin®) a week before endovascular intervention and within a week after. On admission to hospital, in the first hours of stay, in 1, 7 days after surgery, the amount of Bax and platelet growth factor (PDGF BB) biomarkers were determined in the blood serum of all the patients. On control visits, the patients underwent duplex scanning of the arteries of the lower extremities to measure the thickness of the neointima and to detect restenosis of the intervention area. RESULTS: When comparing Bax values in the first hours and days after surgery in groups A and B, its growth was noted in patients of the first group (p < 0.01). At the same time, in patients of group A, the increase in PDGF BB was more pronounced (p < 0.01) on the 7th day. In patients of group A with restenosis of the reconstruction zone, the values of Bax marker in the first hours after surgery exceeded those in patients of group B (р < 0.01). On the 7th day, the amount of PDGF BB in these patients of group A was increased relative to group B (р < 0.01). The changes in the number and dynamics of the studied markers in group B patients with restenosis of the reconstruction zone led, firstly, to decrease in the percentage of stenosis in the area of the previous surgical intervention, secondly, to decrease in the severity of the clinical manifestation of this complication, thirdly, to occurrence of restenosis of the reconstruction zone in the later period, and, fourthly, to decrease in the percentage of patients with this complication. CONCLUSION: The use of combined antioxidant therapy targeted at the system of apoptosis, can reduce the thickness of the neointima of the reconstruction zone and reduce the percentage of patients with restenosis after endovascular interventions.