Abstract
The balance between prostacyclin and thromboxane has been suggested to be of great importance for the maintenance of patency in veins. In order to investigate prostacyclin and thromboxane release, segments from the human saphenous veins were investigated in 53 patients. Twenty-seven patients (10 males, 17 females) underwent surgery for varicose veins. Twenty-six patients (14 nondiabetics, 12 diabetics) underwent surgery for lower limb ischemia (rest pain or gangrene) with use of the saphenous vein as arterial conduit. Vein segments were gently excised and perfusedex vivo for five 15 minute periods, with a balanced salt solution and determination of the stable degradation products 6-keto-PGF1α and TxB2. Saphenous veins from patients with varicose veins had an initial prostacyclin release of 61 ± 13 pg/mm2/15 min declining to 4 ± 1 pg/mm2/15 min after 60 min (p<0.001) and increasing after addition to arachidonic acid to 37 ± 7 pg/mm2/15 min (p<0.001). Segments from nondiabetic patients with lower limb ischemia did not differ from those of varicectomy patients, but diabetic segments had a significantly lower prostacyclin release than both these groups, 34 ± 11 pg/mm2/15 min, 1 ± 1 pg/mm2/15 min, and 7 ± 5 pg/mm2/15 min, respectively (p<0.05). The addition of arachidonic acid failed to increase the prostacyclin release in diabetics. Three patients from each group were studied regarding thromboxane release and there was almost no detectable thromboxane in any group. These findings suggest that diabetics have a lowered prostacyclin release from the saphenous vein and that the deficiency is at the cyclo-oxygenase level. The results could be of importance in thrombogenesis.
Résumé
L'équilibre entre la prostacycline et la thromboxane paraît être important pour maintenir la perméabilité veineuse. Pour explorer la libération de prostacycline et la thromboxane, des segments de veine saphène humaine ont été examinés chez 53 patients. Vingt-sept (10 hommes, 17 femmes) avaient été opérés pour des varices. Vingt-six patients (14 non diabétiques, 12 diabétiques) avaient été opérés d'une ischémie des membres inférieurs (douleur de repos ou gangrène) en utilisant un segment de veine saphène pour remplacer l'artère pathologique. Les veines ont été excisées sans les traumatiser et perfuséesex vivo pendant 15 minutes, cinq fois par une solution salée physiologique. Les concentrations des produits de dégradation stables 6 céto PGF 1 alpha et TxB2 ont été mésurées. Les veines saphènes des patients ayant des varices avaient une libération de prostacycline de 61 ± 13 pg/mm2/15 min qui chutait à 4 ± 1 après 60 min (p<0.001) et, lorsqu'on ajoutait de l'acide arachidonique, augmentait à 37 ± 7 pg/mm2/15 min (p<0.001). La libération de prostacycline des segments des patients non diabétiques ayant une ischémie des membres inférieurs ne différaient pas de celle des segments des patients ayant des varices. En revanche, la libération de prostacycline des patients diabétiques étaient significativement plus basse que dans les deux autres groupes, respectivement, 34 ± 11, 1 ± 1 et 7 ± 5 (p<0.05). L'addition d'acide arachidonique n'a pas augmenté la libération des prostacyclines chez le diabétique. La libération de la thromboxane, étudiée chez trois patients dans chaque groupe, a été presque nulle. Ces données suggèrent que la libération de prostacycline dans la veine saphène est diminuée chez le diabétique, et que ce déficit se situe au niveau de l'oxygènase cyclique. Ces résultats pourraient avoir une importance pour la compréhension de la thrombogénèse.
Resumen
Se ha sugerido que el balance entre la prostaciclina y el tromboxano es de gran importancia para el mantenimiento de la permeabilidad de las venas. Con el objeto de investigar la liberación de prostaciclina y de tromboxano, se estudiaron segmentos de venas safenas en 53 pacientes: 27 (10 hombres, 17 mujeres) fueron operados por venas varicosas; 26 (14 no diabéticos, 12 diabéticos) fueron operados por isquemia de los miembros inferiores (dolor en reposo o gangrena) utilizando vena safena como conducto artificial. Los segmentos venosos fueron cuidadosamente resecados y perfundidos ex vivo con una solución salina balanceada y se determinaron los productos de degradación 6-keto-PGF1 α y TxB2. Las venas safenas de los pacientes varicosos exhibieron una liberación inicial de prostaciclina de 61 ± 13 pg/mm2/15 min, que declinó a 4 ± 1 a los 60 min (p<0.001) y que ascendió con la adición de ácido araquidónico a 37 ± 7 (p<0.001). Los segmentos venosos de los pacientes no diabéticos con isquemia de los miembros inferiores no mostró variación respecto a los pacientes sometidos a varicectomía, pero los de los diabéticos exhibieron una liberación de prostaciclina significativamente menor que tales dos grupos, 34 ± 11, 1 ± 1 y 7 ± 5, respectivamente (p<0.05). La adición de ácido araquidónico no logró incrementar la liberación de prostaciclina en los diabéticos. Se estudiaron 3 pacientes en cada grupo respecto a la liberación de tromboxano y prácticamente no se halló tromboxano detectable en cada grupo. Estos hallazgos sugieren que los diabéticos poseen una liberación disminuida de prostaciclina por la vena safena y que la deficiencia reside a nivel de la ciclo-oxigenasa. Tales resultados pueden revestir importancia en el proceso de la trombogenesis.
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Brunkwall, J.S., Bergqvist, D. Prostacyclin release from the human saphenous vein in diabetics is lower than in nondiabetics. World J. Surg. 16, 1141–1145 (1992). https://doi.org/10.1007/BF02067081
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DOI: https://doi.org/10.1007/BF02067081