The impact of modified governed reperfusion on systemic inflammatory answer in an acute ischemia of the extremity
Abstract
Objective. To study up a possibility of reduction of unfavorable effects of reperfusion on distant organs and systems in an acute ischemia of the extremity.
Materials and methods. In the investigation, conducted in the Zaytsev Institute of General and Urgent Surgery 37 patients were included, operated in 2016 - 2019 yrs for severe acute ischemia due to an acute proximal occlusion of the lower extremity artery. In the Group I (comparative) 23 patients the standard treatment was conducted. In 14 patients of the Group II (the main) during the blood flow restoration, the proposed procedure of modified governed reperfusion in combination with a low-flow hemodialysis was applied in the first 12 h of reperfusion period. Dynamics of concentration of interleukins (IL-1β, IL-6, IL-8, IL-10) and the tumor necrosis factor alpha (TNF-α) during 48 h after the operation in peripheral venous blood was registered. As well in early postoperative period the levels of myoglobin, general creatinphosphokinase, creatinine and potassium were estimated as well.
Results. Raising of concentration of anti-inflammatory cytokines in the blood serum, peculiarly of IL-6 and IL-8, was registered. Application of the method proposed for the governed reperfusion have permitted during first two days to lower concentration of IL-6 by 51 - 67%, and concentration of IL-8 - by the third part. While application of the method proposed the essential lowering of maximal and the average indices of levels of myoglobin and general creatinphosphokinase in the peripheral blood serum was noted as well. Reduction of the renal dysfunction severity and quantity of unfavorable cardio-pulmonary events was noted clinically.
Conclusion. Application of the elaborated method of the governed reperfusion leads to reduction of inflammatory answer and systemic impact of products of ischemic metabolism and rhabdomyolysis in early postoperative period in patients, suffering severe ischemia of lower extremities.
References
Biancari F. Meta-analysis of the prevalence, incidence and natural history of critical limb ischemia. J Cardiovasc Surg (Torino) 2013;54(6):663-9. PMID: 24126504.
Kutepov DE, Zhigalova MS, Pasechnik IN. Patogenez sindroma ishemii-reperfuzii [Pathogenesis of ischemia-reperfusion syndrome]. Kazanskij med. zh. 2018;99 (4):640-44. doi: 10.17816/KMJ2018-640. [In Russian].
Genyk SM, Symchych AV. Reperfusion syndrome after revascularization of lower extremity ischemia. Serce i sudyny. 2016;3:104-8. [In Ukrainian].
Beyersdorf F, Matheis G, Kruger S, Hanselmann A, Freisleben HG, Zimmer G, et al. Avoiding reperfusion injury after limb revascularization: experimental observations and recommendations for clinical application. J Vasc Surg 1989;9(6):757-66. PMID: 2657120.
Dick F, Li J, Giraud MN, Kalka C, Schmidli J, Tevaearai H. Basic control of reperfusion effectively protects against reperfusion injury in a realistic rodent model of acute limb ischemia. Circulation. 2008;118(19):1920-8. doi: 10.1161/CIRCULATIONAHA.108.787754.
Baines C.P. How and when do myocytes die during ischemia and reperfusion: the late phase. J Cardiovasc Pharmacol Ther. 2011;16 (3-4):239-43. doi: 10.1177/1074248411407769.
Walker PM, Romaschin AD, Davis S, Piovesan J. Lower limb ischemia: phase 1 results of salvage perfusion. J Surg Res. 1999;84(2):193-8. doi: 10.1006/jsre.1999.5641.
Heilmann C, Schmoor C, Siepe M, Schlensak C, Hoh A, Fraedrich G et al. Controlled reperfusion versus conventional treatment of the acutely ischemic limb: results of a randomized, open-label, multicenter trial. Circ Cardiovasc Interv. 2013;6(4):417-27. doi: 10.1161/CIRCINTERVENTIONS.112.000371.
Mutirangura P, Chinsakchai K, Wongwanit C, Ratanaratb R, Ruangsetakit C. Successful revascularization with intraoperative venous drainage of ischemic limbs through hemodialysis in severe acute saddle aortic embolism. Eur J Vasc Endovasc Surg. 2010;39(1):123. doi:10.1016/j.ejvs.2009.09.017
Schmidt CA, Rancic Z, Lachat ML, Mayer DO, Veith FJ, Wilhelm MJ. Hypothermic, initially oxygen-free, controlled limb reperfusion for acute limb ischemia. Ann Vasc Surg. 2015;29(3):560-72. doi: 10.1016/j.avsg.2014.09.033.
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