Prevention of reperfusion injury in patients operated on for acute lower limb ischaemia

Abstract

Objective: to improve the results of treatment of patients with reperfusion syndrome after operations of open revascularization for embolism and acute thrombosis of lower limb arteries.Material and methods. From 2013 to 2017 in the department of acute vascular diseases SI «V.T. Zaytsev IGUS NAMS of Ukraine» were operated 154 patients admitted with acute ischemia of the lower extremities. Depending on the management in the perioperative period, the patients were divided into 2 groups: 91 patients of group I received conventional treatment, group II included 63 patients who underwent comprehensive prophylaxis of reperfusion injuries. All patients were determined by the dynamics of the levels of creatinine, potassium, lactic acid, low and medium molecular weight substances in the blood plasma.Results. In the postoperative period, various manifestations of renal dysfunction were observed in 21 patients (23.1%) of the first group and in 12 patients (19%) of the second group, 2 patients of the first group needed acute hemodialysis. 20 patients of group I (22.0%) and 13 patients of group II (20.6%) manifested with clinically significant worsening of cardio-pulmonary insufficiency in the postoperative period. In 13 patients of group I (14.3%) and in 8 patients of group II (12.7%) cognitive impairment was diagnosed in the postoperative period. Overall mortality in both groups was not significantly different. The use of comprehensive therapy allowed to reduce reperfusion lesions of distant organs, manifestations of endogenous intoxication, as well as their clinical manifestations, but did not affect the number of amputations in these categories of patients. Conclusions 1. An correlation of the clinical presentation of reperfusion injury of ischemic tissues and vital organs with biochemical parameters and markers of endogenous intoxication of blood plasma in patients with acute limb ischemia after operations revascularization was revealed. 2. Comprehensive prevention and correction of reperfusion syndrome manifestations significantly improves the course of the postoperative period.