Longitudinal measurements of NO-mediated vasodilation and physical activity over one year following endometriosis excision surgery: a passive experiment.

Abstract

Women with endometriosis are at increased risk of cardiovascular disease and demonstrate endothelial dysfunction. The gold standard for diagnosis of endometriosis is through operative laparoscopy with surgical excision and histopathologic identification of endometrial-type glands and stroma. Symptoms of endometriosis are often immediately improved or resolved following excision surgery, but the cardiovascular impact of excision surgery is underappreciated. This passive experiment reports the longitudinal adaptations of the macrovascular and cutaneous microvascular endothelium in a single patient following surgical excision of endometriosis. The patient participated in multiple vascular research studies targeting nitric oxide-mediated vasodilation over the course of the succeeding 13 months post-surgery. We show no nitric oxide (NO)-mediated vasodilation in the microvascular endothelium (-34 AU) and no flow-mediated dilation (FMD) in the brachial conduit artery (-0.06%) one-month post-surgery with a recovery seeming to occur ~8 months post-surgery (178 AU, 3.69% FMD) that does not remain ~13 months post-surgery (3 AU, 0.43%). These values occur in tandem with reported exercise prior to testing (1746 to 3759 to 1954 MET-min/wk, respectively). The results of these studies, placebo and baseline visits, are presented here. These findings suggest that microvascular endothelial function in an otherwise healthy young woman with endometriosis is not necessarily recovered following excision surgery, but may be dramatically improved with resistance exercise. Our data may lend insight into the progression of vascular dysfunction in this disease and the role of surgical vs. lifestyle intervention in this realm.