Lower limb ischemia: Phase 1 results of salvage perfusion

Revascularization of an ischemic lower extremity is associated with high mo rbidity (20-30%) and perioperative mortality (10-20%) regardless of the mod e of intervention, surgical or thrombolytic, considered to be due to polymo rphonuclear (PMN) activation and mediator release, In this study, the safet y and feasibility of cell-free extracorporeal perfusion of the limb with a solution designed to minimize both local and systemic injury was tested. Methods, Patients with severe limb ischemia (sensory/motor loss, rest pain/ gangrene) were studied prospectively by random assignment into the treatmen t arm (n = 14) or control arm (n = 21). Surgical management consisted of re storative procedure, thrombectomy or embolectomy (n = 21), or reconstructio n (n = 14), Reperfusion of the ischemic limb was achieved with hypertonic, hyperoncotic perfusate containing anti-oxidants delivered via the arterial tree (mean volume 1835 +/- 824 mi) with initial venous drainage (mean volum e 775 +/- 263 mi) in the restorative group. Means were compared by paired t test. Results. No adverse systemic effects were detected after limb perfusion (el ectrolytes, coagulation, platelet function, CBC), Rapid lactate wash-out wa s observed within 30 min of perfusion (preperfusion 3.2 +/- 4.1 mM, 30 min postperfusion 0.7 +/- 0.71 mM, P < 0.01). Blunting of PMN activation was sh own by chemiluminescence (CL) analysis (preischemic CL: 0.68 +/- 0.2; 30 mi n CL: 0.47 +/- 0.2; P < 0.013). F2-isoprostanes, a marker of free radical-m ediated systemic lipid peroxidation, were significantly reduced in patients treated with study perfusion method (70.55 +/- 39.54 versus control 194.38 +/- 25.24, P < 0.005), Mortality with treatment was 0/14 versus 5/21 in th e control. Complication frequency: MI 0/14 vs 3/21; renal 0/14 vs 1/21; leg edema 1/14 vs 5/21; amputations 2/14 vs 1/21. Conclusion. Modification of limb perfusion in patients with severe limb isc hemia, using our simple and rapid (15-20 min) method provides beneficial sy stemic effects, (C) 1999 Academic Press.