Abstract
Acute ischemia-reperfusion (I/R) of extremities means serious challenge in the clinical practice. Furthermore, the issue of preventive cooling is still controversial. In this canine model we investigated whether limb I/R -with or without cooling- has an influence on hematological and hemostaseological factors. Femoral vessels were exposed and clamped for 3 hours. After release the clamps, 4-hour reperfusion was secured. The same procedures with cooling using ice bags, as well as warm and cold sham-operations were performed. Before operations, from the excluded limb by the end of ischemia, during the reperfusion, and for 5 postoperative days afterwards blood samples were collected for testing hematological and blood coagulation parameters. After I/R activated partial thromboplastin time was elongated on 2nd-4th postoperative days. The highest values were on the 2nd day in cold I/R group, accompanied by increased prothrombin time values. The hematological parameters and fibrinogen level showed non-specific changes. In excluded ischemic limb the blood composition showed controversial data. Cold ischemia induced larger alterations, however platelet count, hematocrit changed more expressly in warm ischemia. These results indicate the risk of coagulopathy following limb I/R on early post-eventually days, which risk is higher in the case of cold I/R.
Highlights
Operative techniqueAcute limb ischemia and reperfusion means serious challenge in the clinical practice of trauma cases, when the duration and degree of ischemia and the temperature are variable factors
This study describes coagulopathy and other hematological effects comparing normo- and hypothermic limb ischemia-reperfusion
The main conclusions are: (1) Three-hour ischemia and the following reperfusion resulted in both non-specific and specific changes in hematological and hemostasis parameters, which alterations were enlarged in the case of cold ischemia
Summary
Acute limb ischemia and reperfusion means serious challenge in the clinical practice of trauma cases, when the duration and degree of ischemia and the temperature are variable factors. Several case reports and experiences are about the attempted replantation of arms or lower extremities following their traumatic amputation, the occurred hyperkalemia, acidemia and severe hypotension, and sometimes the re-amputation was necessary to treat the complex systemic effects of the reperfusion or revascularisation syndrome[2]. Ischemia-reperfusion results in complex alterations in hemodynamics as well as in endothelial function and microcirculation, causing local and systemic metabolic changes, and alters fluid equilibrium and induces complement and inflammatory pathways[3,4,5,6,7,8,9]. We hypothesized that limb ischemia-reperfusion at normo- or hypothermia variously alters blood coagulation parameters. Earlier our team has developed a hind limb ischemiareperfusion experimental canine model in order to investigate local and systemic alterations in complex blood parameters[17,18]. In a previous paper the hemorheological alterations were reported[19], in recent study we summarize the local and systemic hematological and hemostaseological changes
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