ISCHEMIA - REPERFUSION SYNDROME OF THE LOWER-LIMBS

The ischemia-reperfusion syndrome, first described by Haimovici in 196 0, is a severe complication following surgery for acute ischemia. We e valuated the incidence of this complication in 264 patients operated o n between 1972 and 1981 (1st group) and compared it with another of 39 2 patients operated on between 1982 and 1991 (2nd group), our aim bein g to assess the effects of pharmacological prophyiaxis based on preope rative overhydration followed by an intra-arterial bolus of 250 ml 14/ 1000 HCO3-, containing 1 g dexamethasone and 2500 I.U. sodium heparin, injected into the femoral artery before suturing the arteriotomy. Thi s regimen was based on the measurement of myoglobin and glutathione le vels respectively carried out in two subgroups of 25 patients. The res ults of experimental ischemia-reperfusion syndromes induced in animal using radical scavengers and membrane-protective compounds were also t aken into consideration. Following experimental research on sheep, 5 p atients in the second group with very severe ischemia due to aortic oc clusion received local dialysis in the extracorporeal circulation usin g hemodialysis or hemofiltration techniques. Mortality was 6.3% in the first group and 5.4% in the second, while the amputation rate was 3% and 1.8% respectively. The overall incidence of the reperfusion syndro me was 3% in the Ist period and 1.8% in the second. Our findings confi rm the protective effect of hyper-hydration, radical scavengers and de xamethasone in the ischemia reperfusion syndrome, and indicate that lo cal hemodialysis is a useful adjunct in very severe ischemia.