Controlled limb reperfusion in patients having cardiac operations

Abstract

These findings show that controlled limb reperfusion can be applied readily with standard equipment that is used for cardiac surgery and may salvage limbs while reducing postreperfusion morbidity and mortality.

Basic Control of Reperfusion Effectively Protects Against Reperfusion Injury in a Realistic Rodent Model of Acute Limb Ischemia

“…15 For acute limb ischemia, however, clinical data are scarce. Although small case series have reported striking results after up to 24 hours of ischemia 24,25,33 and a recent study claimed impressive benefits over simple embolectomy and immediate blood reperfusion, 27 a randomized controlled trial could not show any benefits regarding local outcome. 26 Nevertheless, experimental data are very promising, 15 and clinical success may depend mainly on a systematic optimization of an applicable reperfusion protocol worth being translated.…”

The Influence of Controlled Limb Reperfusion With PGE1 on Reperfusion Injury After Prolonged Ischemia

“…The rationale of controlled reperfusion is that introduction of hypocalcemic, hyperosmotic, substrate-enriched reperfusate at low pressure (around 40 mm Hg) for relatively prolonged time period (30 min) after restitution of blood flow should beneficially affect both local and systemic sequelae [5,12,28]. This has been proven experimentally [14], clinically [29], and in part in this study. The addition of PGE1 to the controlled reperfusion has been suggested to bring additional benefit, mainly through attenuation of the ''reflow paradox'' [24].…”

Hypothermic, Initially Oxygen-Free, Controlled Limb Reperfusion for Acute Limb Ischemia

“…15,19,21 Despite the application of several measures to reduce the extent of IR injury, as outlined above, the overall mortality of our patients was not markedly reduced as compared with that in other studies. 17 They found an 84% complete limb recovery rate, a 16% mortality rate (33% mortality in patients with distal aortic occlusions), and a 63% fasciotomy rate. Defraigne reported on 2 cases.…”

“…Similarly, the rate of fasciotomy performed in 10 of the 36 patients (27.8%), as well as the need for amputation in 4 of the 36 patients (11.1%) matches well with the results of other groups. 17,20 In addition, the exceptionally long duration of acute ischemia of 33.7 hr (range 7e96 hr) may have had a major impact on outcome. Apart from the importance of a remaining collateral circulation, time delay from onset of acute ischemia to treatment has been shown to affect clinical outcome directly.…”