PERIOPERATIVE VASCULAR FLUSHING PERFUSION IN ACUTE MESENTERIC-ARTERY OCCLUSION

Aim: To evaluate in animals and patients a perioperative vascular flus hing perfusion with antioxidants in order to improve postischaemic con dition of the bowel and hence, to prolong the warm ischaemia tolerance time. Materials: 40 rats and 10 patients with acute mesenteric artery occlusion. Methods: Intestinal ischaemia was induced in 40 vats by cl ipping the superior mesenteric artery for 1 h. Thirty animals received a vascular flushing perfusion with oxygen radical scavengers (ascorba te, tocopherol or oxypurinol). Histology, ATP ADP levels were examined in tissue biopsies and malondialdehyde, lactate dehydrogenase, alkali ne phosphatase levels were measured in blood during ischaemia and 60 m in after reperfusion. Results: ATP restoration was particularly improv ed in the oxypurinol group (ATP/ADP-ratio=2 vs. 1.2 in the control gro up). Malondialdehyde increase observed after reperfusion as a marker o f radical induced lipid destruction was significantly attenuated (cont rol group 160% of base level vs. 127% in the ascorbate group, 133% in the tocopherol group, 121% in the oxypurinol group). Histological alte rations during ischaemia/reperfusion were markedly less extensive in t he perfusion groups than in control. The patients treated perioperativ ely with arterial flashing perfusion had an overall mortality of 10%. Conclusion: Vascular Pushing perfusion with oxygen radical scavengers prevents radical induced ischaemic damage and may prolong the warm isc haemic tolerance time of the intestine.