Controlled limb reperfusion with a simplified perfusion system

The goal of revascularisation of an acutely ischemic limb is to prevent the loss of the extremity and to enable return of normal function. Although re perfusion of an ischemic limb is a prerequisite for the preservation or ree stablishment of function, it may, in itself, cause further injury. Controll ed reperfusion after revascularisation may reduce this injury and may facil itate return of normal function. Thus far, the technique of controlled limb reperfusion required the use of cardiosurgical equipment and has therefore been reserved for cardiac surgery centers. However, the majority of patien ts with acute limb ischemia are referred to hospitals, where the technical equipment for controlled reperfusion is not available. We modified the tech nique of controlled limb reperfusion using a simplified perfusion system wi th a pressure-cuffed bag, which allows controlled reperfusion without the u se of a roller pump. The modified reperfusion technique was applied to 9 pa tients with acute and persistent ischemia of the limbs (mean ischemic perio d: 21+/-21 hours). Controlled reperfusion consisted of a 30 min infusion of a normothermic reperfusate solution, which was mixed with the patient's bl ood (6:1, blood/reperfusate ratio) distally to the proximal obstruction. Re sults: Five patients (56%) recovered with normal function of the limb. Two patients (22%) lost the ischemic limb (ischemic periods: 77 h and 9 h: crea tine kinase before operation: 6230 U/I and 1045 U/I); another two patients (22%) died, who were in profound cardiogenic shock. Conclusion: The simplif ied perfusion system allows to put controlled limb reperfusion into practic e in any operating room. The results support the notion that controlled lim b reperfusion should be applied in any patient with acute ischemia of an ex tremity.