Postconditioning of the lower limb-protection against the reperfusion syndrome

Endre Gyurkovics, Peter Aranyi, Rita Stangl, Peter Onody, Gabor Ferreira, Gabor Lotz, Peter Kupcsulik, Attila Szijarto

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Postconditioning - alternating brief cycles of reperfusion/reocclusion applied at the beginning of revascularization - is a potent therapeutic technique, attenuating ischemia-reperfusion injury. Vascular surgery on the lower limb with ischemia-reperfusion injury may give rise to serious systemic complications [organ dysfunction syndrome (MODS), systemic inflammatory response syndrome (SIRS)], a phenomenon called reperfusion- syndrome. Material and Methods: We studied the effects of postconditioning on reperfusion-syndrome in a rodent experimental model. Wistar rats underwent 180 min of bilateral lower limb ischemia using an infrarenal crossclamping of the abdominal aorta. Postconditioning consisted of six cycles of 10-s aortic occlusion/10-s declamping at the beginning of reperfusion. Microcirculation of the lower limb was detected with laser Doppler flowmeter. After 4 h of reperfusion, plasma, urine, and histologic samples were collected. Results: One hundred eighty-minute ischemia resulted in significant hemodynamic changes after reperfusion. Postconditioning affected the character of the microcirculatory flow, the limb circulation stabilized with hyperemia during reperfusion. Postconditioning caused a significant reduction in systemic inflammatory response (TNF-α, oxygen-derived free radicals). The laboratory and histologic samples implied a significant decrease in distant organ (lung and renal) dysfunctions after postconditioning. Conclusion: Postconditioning proves to be capable of conferring protection against different organ injuries caused by longer circulatory occlusions during elective major vascular operations.

Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalJournal of Surgical Research
Volume169
Issue number1
DOIs
Publication statusPublished - Jul 1 2011

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Keywords

  • acute renal failure
  • ischemia-reperfusion injury
  • limb ischemia
  • postconditioning
  • reperfusion syndrome
  • systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Surgery

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