PATHOGENETIC SUBSTANTIATION OF PREVENTION AND CORRECTION OF REPERFUSION-REOXYGENATIVE SYNDROME AT REVASCULARIZATION OF THE ARTERIAL BED IN CONDITIONS OF CHRONIC CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES
DOI:
https://doi.org/10.11603/2415-8798.2019.2.10268Keywords:
occlusion, arteries, complications, pathogenesis, prophylaxisAbstract
The article indicates the prevalence of occlusive-stenotic lesions of the arterial lumen of the lower extremities and the frequency of postoperative complications after revascularization in the form of reperfusion-reoxygenative syndrome (RRS). The pathogenetic mechanisms and processes of RRS development that can be suspended or their manifestation can be significantly reduced in the application of a set of measures, which should be aimed at: a) reducing the activity of neutrophils; b) normalization of the state of endothelial cells; c) elimination of vasoconstriction; d) normalization of microvascular permeability; e) restoring the prooxidant-antioxidant balance. For prophylaxis and correction of RRS it was proposed to use infusion of prostaglandin E1, prolonged epidural anesthesia, polyclonal antineutrophil serum, monoclonal antibodies, L-selectin, leukapheres, statins, beta-blockers, angiotensin-converting enzyme inhibitors, indoleacetic acid derivatives, catalase, mannitol, allopurinol, alpha- tocopherol, corvitin, L-arginine.
The aim of the study – pathogenetical substantiation of reperfusion-reoxygenative syndrome prevention in the revascularization of the arterial bed in conditions of chronic critical ischemia of the lower extremities.
Materials and Methods. The material for the work were data from literature over the past 5–10 years on the issue of critical ischemia of the lower extremities and revascularization of the arterial line to find out the current trends and views on the causative factors of reperfusion-reoxygenative syndrome development.
Results and Discussion. The results of researches testify that the basis of RRS is the arrival of oxygenated blood in the arterial channel of the ischemic lower limb. The formed RRS prolongs ischemia of lower limb tissues and promotes the progression of dystrophy, which exhibit generalized depressive effects on organs and systems. For prophylaxis and correction of RRS it is proposed to use infusion of prostaglandin E1, prolonged epidural anesthesia, polyclonal antineutrophil serum, monoclonal antibodies, L-selectin, leukapheres, statins, beta-blockers, angiotensin-converting enzyme inhibitors, indoleacetic acid derivatives, catalase, mannitol, allopurinol, alpha- tocopherol, corvitin, L-arginine.
Conclusions. The starting factor of the complex of pathogenetic mechanisms and processes of development of RRS is the discrepancy between the amount of oxygen in the blood entering the arterial system of the lower limb during a revascularizing operation and its ability to be consumed by reoxygenated ischemic tissues. The indicated pathogenetic mechanisms and processes of RRS development may be suspended or their manifestation can be significantly reduced by applying a set of measures that should be directed to:
a) decrease of activity of neutrophils; b) normalization of the state of endothelial cells; c) elimination of vasoconstriction; d) normalization of microvascular permeability; e) restoration of prooxidant-antioxidant equilibrium.
References
Dibyak, Yu.M. (2014). Stan hemodynamiky pry riznykh morfolohichnykh variantakh urazhennia arterialnoho rusla patsiientiv iz khronichnoiu krytychnoiu ishemiieiu nyzhnikh kintsivok. [The state of hemodynamics in various morphological variants of affection of arterial lumen of patients with chronic critical ischemia of the lower extremities]. Krovoobih ta hemostaz – Blood circulation and hemostasis, 1-2, 73-77 [in Ukrainian].
Belov, Yu.V., Vinogradov, O.A., Ulyanov, N.D., & Dziundzia, A.N. (2014). Prognozirovaniye rezultatov revaskulyariziruyushchikh operatsii na arteriyakh nizhnikh konechnostey na osnove metodov otsenki regionarnogo krovotoku [Prognosis of the results of revascularization operations on the lower limb arteries based on the methods of evaluation of regional blood flow]. Kardiologiya i serdechno-sosudistaya khirurgiya – Cardiology and Cardiovascular Surgery, 7 (5), 62-67 [in Russian].
Boyko, V.V., Fetisov, S.A., & Okley D.V. (2013). Rezultaty khirurgicheskogo lecheniya bolnykh s khronicheskoy ishemiyey nizhnikh konechnostey [Results of surgical treatment of patients with chronic lower limb ischemia]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 5, 87-89 [in Russian].
Marshalov, D.V., Petrenko, A.P., & Hlusha, I.A. (2008). Reperfuzionnyy sindrom: ponyatiye, opredeleniye, klassifikatsiya. [Reperfusion syndrome: concept, definition, classification]. Patologiya krovoobrashcheniya i kardiologiya – Pathology of blood circulation and cardiology, 3, 67-72 [in Russian].
Dick, F., Li, J., Girarud, V.N., Kalka, C., Schmidli, J., & Tevaearai, H. (2008). Basic control of reperfusion effectively protects against reperfusion injury in a realistic rodent model of acute limb ischemia. Circulation, 4, 118 (19), 1920-1928. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.787754
Moler III, E.R., & Dzhaff, M.R. (ed.) (2010). Zabolevaniia perifericheskikh arterii [Diseases of peripheral arteries]. (Transl). Moskov, RF : GEO-TAR-Media, p. 224 [in Russian].
Saveliev, V.S., & Kirienko, A.I. (ed.) (2010). Klinicheskaya khirurgiya. v 3 t. [Clinical surgery : in 3 vol.]. Moscow, Russia: GEOTAR-Media; III. p. 1008 [in Russian].
Kalinin, R.E., Pshennikov, A.S., & Suchkov, V.A. (2015). Reperfusion tissue damage in the surgery of lower limb arteries [Reperfusion tissue damage in lower limb artery surgery]. Novosti khirurgii – Surgery news, 23 (3), 348-352 [in Russian].
Kovalchuk, L.Ya., Venger, I.K., Kostiv, S.Ya., & Shkrobot, L.V. (2005). Vybir obyemu rekonstruktsii pry aterosklerotychnii okliuzii terminalnoho viddilu aorty ta mahistralnykh arterii nyzhnikh kintsivok [Choose of reconstruction volume at atherosclerotic occlusion of the terminal aorta and trunk arteries of the lower extremities]. Shpytalna khirurhiia – Hospital Surgery, 1, 6-10 [in Ukrainian].
Blaisdell, F.W. (2002). The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg. Des., 10 (6), 620-630. DOI: https://doi.org/10.1016/S0967-2109(02)00070-4
Kalinin, R.E., Sochkov, I.A., & Pshenkov, A.S. (2014). Endotelialnaya disfunktsiya i sposoby yeye korrektsii pri obliteriruyushchem ateroskleroze [Endothelial dysfunction and methods of its correction in obliterating atherosclerosis]. Moscow, RF : GEOTAR-Media, p. 152 [in Russian].
Kuznetsov, M.R., Koshkin, V.M., & Komov, K.V. (2006). Sovremennyye aspekty diagnostiki, profilaktiki i lecheniya reperfuzionnogo sindroma [Modern aspects of diagnostics, prevention and treatment of reperfusion syndrome]. Angiologiya i sosudistaya khirurgiya – Angiology and Vascular Surgery, 12 (1), 133-143 [in Russian].
Ioskevich, N.N. (2007). Khirurgiya khronicheskoy ishemii nizhnikh konechnostey ateroskleroticheskogo geneza [Surgery of chronic lower limb ischemia of atherosclerotic genesis]. Grodno, Belarus: GSMU; p. 315 [in Russian].
Proebstl, D., Voisin, M.B., Woodfin, A., Whiteford, J., D’Aсquisto, F., Jones, G.E., et al. (2012). Pericytes support neutrophil subendothelial cell crawling and breaching of venular walls in vivo. J Exp Med., 4, 209 (6), 1219-1234. DOI: https://doi.org/10.1084/jem.20111622
Sochkov, I.A., Pshennikov, A.S., Gerasimov, A.A., Agapov, A.B., & Kamaev, A.А. (2013). Profilaktika restenozov v rekonstruktivnoy khirurgii magistralnykh arteriy [Prevention of restenoses in reconstructive surgery of trunk arteries]. Nauka molodykh - Eruditio Juvenium – Young Science - Eruditio Juvenium, (2), 12-19 [in Russian].
Suchkov, I.A., & Kalinin, R.E. (2013). Endoteliotropnaya terapiya kak sposob profilaktiki restenoza zony rekonstruktsii i korrektsii disfunktsii endoteliya u patsiyentov s obliteriruyushchim aterosklerozom ar-teriy nizhnikh konechnostey [Endotheliotropic therapy as a method of prevention of restenosis of the reconstruction zone and correction of endothelium dysfunction in patients with obliterating atherosclerosis of the arteries of the lower extremities]. Kardiologiya i Serdech-Sosud Khirurgiya – Cardiology and Cardiovascular Surgery, 6 (5), 54-57 [in Russian].
Yakusheva, E.N., Chernykh, I.V., Shulkin, A.V., & Hatsanuga, M.V. (2015). Ishemiya i ishemiya-reperfuziya kak modulyator funktsionirovaniya belka-transportera glikoproteina-R [Ischemia and ischemia-reperfusion as a modulator of the protein-transporter glycoprotein-P function]. Farmatsiya i Farmakologiya –Pharmacy and Pharmacology, (5s), 124-125.
Kolotylo, A.B., Venger, I.K., Kostiv, S.Ya., & Ifodiy, A.G. (2018). Disfunktsiya endoteliya i osobennosti mikrotsirkulyatsii u patsiyentov s visokim riskom razvitiya reperfuzionnogo sindroma v usloviyakh revaskulyarizatsionnoy operatsii [Endothelial dysfunction and specifics of microcirculation in patients with high risk of reperfusion syndrome conditions of revascularizing operation]. Georgian medical news., 2, 2-11 [in Russian].
Khiabani, H.Z., Anvar, M.D., Kroese, A.J., & Stranden, E. (2000). Transcapillary forces and the development of oedema in the lower limb of patients with chronic critical ischemia (CLI). Eur J Vasc Endovasc Surg., 19 (6), 598-604. DOI: https://doi.org/10.1053/ejvs.2000.1073
Coats, P., & Hillier, C. (2000). Differential responses in human subcutaneous and skeletal muscle vascular beds to critical limb ischemia. Eur. J. Vasc. Endovasc. Surg., 19 (4), 387-395. DOI: https://doi.org/10.1053/ejvs.1999.1023
Makeeva, A.V., Popova, T.N., Sukhoveeva, O.V., & Panchenko, L.F. (2010). Vliyaniye guanidinovykh proizvodnykh na aktivnost superoksiddismutazy i katalazy pri postishemicheskoy reperfuzii golovnogo mozga u krys [Influence of guanidine derivatives on the activity of superoxide dismutase and catalase in post-ischemic reperfusion of the brain in rats]. Neirokhimiia – Neurochemistry, (3), 245-250 [in Russian].
Manukhina E.B., Terekhina O.L., Belkina L.M., Abramochkin D.V., Budanova O.P., Masina S.Yu., et al. (2013). Vazoprotektornyi effekt adaptatsii pri ishemicheskom i reperfuzionnom povrezhdenii serdtsa [Vasoprotective effect of adaptation in ischemic and reperfusion damage to the heart]. Patol Fiziologiya i Eksperim Terapiya – Patol Physiology and Experimental Therapy, (4), 26-31 [in Russian].
Kozlov, I.A., Romanov, A.A., Dzibinskaya, E.V., & Balandyuk, A.E. (2011). Ingalyatsionnyy oksid azota dlya profilaktiki narusheniya arterialnoy oksigenatsii pri revaskulyarizatsii miokarda s iskusstvennym krovoobrashcheniyem [Inhaled nitric oxide to prevent arterial oxygenation disorders during myocardial revascularization with artificial blood circulation]. Obshch. Reanimatologiya – General Reanimatology, 7 (1), 31-35 [in Russian].
Gladwin, M.T., Kato, G.J., Weiner, D., Onyekwere, O.C., Dampier, C., Hsu, L. et al. (2011). Nitric oxide for inhalation in the acute treatment of sickle cell pain crisis: a randomized controlled trial. JAMA, 305 (9), 893-902. DOI: https://doi.org/10.1001/jama.2011.235
Baines, C.P. (2011). How and when do myocytes die during ischemia and reperfusion: the late phase. J Cardiovasc Pharmacol Ther., 16 (3-4), 239-243. DOI: https://doi.org/10.1177/1074248411407769
Harkin, D.W., Barros, D.Sa.A.A., McCallion, K., Hoper, M., Halliday, M.I., & Campbell, F.C. (2001). Bactericidal permeability-increasing protein attenuates systemic inflammation and acute lung injury in porcine lower limb ischemia-reperfusion injury. Ann Surg. Aug, 234 (2), 233-244. DOI: https://doi.org/10.1097/00000658-200108000-00014
Ioskevich, N.N., & Zinchuk, V.V. (2004). Prooxidant-antioxidant balance in blood during the surgical treatment of obliterating arterial atherosclerosis in the lower extremities. Rocz Acad Med Bialst., 49, 222-226.
Kostiv, S.Ya., Kolotilo, O.B., Venger, I.K., Kostiv, O.I., & Zarudna, O.I. (2018). Patofiziolohichno obhruntovana profilaktyka ta likuvannia reperfuziino-reoksyhynatsiinoho syndromu pry revaskuliaryzatsii nyzhnikh kintsivok v umovakh khronichnoi krytychnoi ishemii nyzhnikh kintsivok [Pathophysiologically grounded prophylaxis and treatment of reperfusion-reoxygenative syndrome with revascularization of the lower extremities in conditions of chronic critical ischemia of the lower extremities]. Naukovyi visnyk uzhhorodskoho universytetu, seriia “Medytsyna” – Scientific herald of Uzhhorod University, series Medicine, 2 (58), 24-28 [in Ukrainian].
Gavrilenko, A.V., & Shabaltas, E.D. (2003). Sostoyaniye mikrotsirkulyatsii pri reperfuzionnom sindrome posle rekonstruktivnykh operatsiy na sosudakh nizhnikh konechnostey [The state of microcirculation in reperfusion syndrome after reconstructive operations on the vessels of the lower extremities]. Khirurhiia. Zhurn. im N. I. Pirogova – Surgery. Journal N. Pyrohov, (2), 62-65 [in Russian].
Kostiv, S.Ya. (2006). Korektsiia reperfuziinoho syndromu pry khirurhichnomu likuvanni patsiientiv iz aterosklerotychnoiu okliuziieiu aorto/klubovo-stehnovoho sehmenta. [Correction of reperfusion syndrome in surgical treatment of patients with atherosclerotic occlusion of the aorta/iliac-femoral segment]. Shpytalna khirurhiia – Hospital Surgery, 1, 36-40 [in Russian].
Gourdin, M.J., Bree, B., & De Kock, M. (2009). The impact of ischemia-reperfusion on the blood vessel. Eur J Anaesthesiol., 26 (7), 537-547. DOI: https://doi.org/10.1097/EJA.0b013e328324b7c2
Kovalchuk, L.Ya., Venger, I.K., Yakymchuk, O.A., & Chepil, I.V. (2010). Leykaferez u profilaktytsi syndromu systemnoi zapalnoi vidpovidi. [Leucopheresis in the prevention of systemic inflammatory response syndrome]. Zdobutky klinichnoi ta eksperymentalnoi medytsyny – Achievements of clinical and experimental medicine, 1, 70-72 [in Ukrainian].
Kalinin, R.E., Pshennikov, A.S., & Suchkov, I.A. (2015). Reperfuzionnoye povrezhdeniye tkaney v khirurgii arteriy nizhnikh konechnostey [Reperfusion tissue damage in lower limb artery surgery]. Novosti Khirurhii – Surgery News, 23 (3), 348-352.
Downloads
Published
How to Cite
Issue
Section
License
Authors who sent their manuscript to "Вісник наукових досліджень. Bulletin of Scientific Research" Surgery agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. 
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
