Local perivascular adiponectin associates with lower extremity vascular operative wound complications

Abstract

Background Wound complication rates after lower extremity vascular surgery procedures stand as high as 40%, and represent a major cause of morbidity, mortality, and cost. In view of increasing recognition of adipose tissue involvement in homeostasis and the response to injury, we hypothesized that adipose phenotype links to surgical wound outcomes. Methods Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected at the time of surgery in patients undergoing lower extremity revascularization (LER) and lower extremity amputations (AMP). Nine biologic mediators [adiponectin, interleukin (IL)-1β, IL-6, IL-8, leptin, monocyte chemoattractant protein (MCP)-1, plasminogen activator inhibitor (PAI)-1, resistin, and tumor necrosis factor (TNF)] were assayed in the adipose tissues and plasma. 30-Day wound complications were captured real time. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution and data were compared using the Student's t-test. Bonferroni correction was used for multiple comparisons. Results Sixty-six patients undergoing LER or AMP for severe PAD were enrolled. The 30-day follow-up rate was 92.4%. In total, 19 (29%) patients developed wound complications. Patients who developed wound complications had elevated perivascular adiponectin levels (mean±standard error, 2372.45±648.64ng/ml versus 832.53±180.54ng/ml, p=0.004). Perivascular IL-1β levels were lower among patients with wound dehiscence (0.41±0.004pg/ml versus 0.73±0.09pg/ml, p=0.001). Conclusions Local adipose tissue mediator levels at the time of operation demonstrate a previously un-described compartment-specific relationship to wound outcomes in patients undergoing lower extremity vascular surgical procedures. These associations provide fertile directions for defining the mechanisms underlying the pathogenesis of wound complications and their prevention.

Human Perivascular Adipose Tissue as a Regulator of the Vascular Microenvironment and Diseases of the Coronary Artery and Aorta

“…Dysfunctional adipocytes secrete less adiponectin, and promotion of healthy adipogenesis may rescue this deficit 6 . Despite its protective effect, patients with a BMI above 30 had increased adiponectin secretion from PVAT 6 , as did symptomatic patients with carotid stenosis 28 and patients with wound complications defined as any type of surgical site infection, dehiscence, or other (seroma, lymphocele, hematoma) 29 .…”