CLINICAL, INSTRUMENTAL AND LABORATORY CHARACTERISTICS OF THE REPERFUSION-REOXYGENATION SYNDROME IN PATIENTS WITH ATHEROSCLEROTIC OCCLUSION OF THE AORTIC/ILIAC-FEMORAL BED IN THE CONDITIONS OF CHRONIC THREATENING ISCHEMIA OF THE LOWER EXTREMITIES
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i2.14716Keywords:
reperfusion-reoxygenation syndrome, atherosclerosis, occlusion, chronic threatening ischemia of the lower extremitiesAbstract
SUMMARY. A technically successful operation does not guarantee restoration of peripheral blood flow and preservation of the lower extremity, which is most often encountered during revascularization of patients with atherosclerotic occlusion of the aortic / iliac-femoral bed.
The aim – to study the clinical, instrumental and laboratory characteristics of the reperfusion-reoxygenation syndrome in patients with atherosclerotic occlusion of the aortic / iliac-femoral bed in the conditions of chronic threatening ischemia of the lower extremities.
Materials and Methods. 55 patients with occlusion of the aortic-bifemoral arterial bed in the conditions of IIb-IV grade of CAI (chronic arterial insufficiency) (according to the Rutherford classification) were subjected to examination and operative treatment. The patients were divided into groups: group I – 29 patients with IIb-IV stages of CAI, group II – 26 patients with III-IV stages of CAI with a high degree of development of reperfusion-reoxygenation syndrome.
Results. During the examination of 26 patients with aortic / iliac-femoral bed occlusion (AIFB) in the conditions of chronic threatening ischemia of the lower extremities and the risk of developing reperfusion-reoxygenation syndrome (RRS), a marked violation of cholesterol-lipid metabolism was revealed.
Restoration of blood flow in AIFB promotes a 1.4–1.8 (p<0.05) times increase in the blood level of both pro-inflammatory and anti-inflammatory cytokines; a 1.5-1.7 (p<0.05) increase in the activity of non-specific proteinases and their inhibitors, activates the processes of free radical oxidation, an increase in the level of lactate in the regional venous blood, an increase in the level of transcutaneous tissue oxygen tension (TcPO2) in the rear foot in patients without a threat of RRS development up to 34 .54±6.01 mmHg, and in patients with a risk of developing RRS – up to 23.67±5.62 mmHg. After revascularization in patients with RPS, the cutaneous blood flow velocity (CBV) of the rear foot reached the level of (30.75±5.48) ml/min.100g, which is 19.8 % lower than the level of cutaneous blood flow velocity (CBV) of the rear foot in patients without RRS.
Conclusions. Clinical, instrumental and laboratory characteristics of the reperfusion-reoxygenation syndrome is a complex system of interrelated reactions that activate pro-inflammatory and anti-inflammatory cytokines, non-specific proteinases and their inhibitors, the pro-oxidant-antioxidant system, the wrapping clotting system, intensify tissue ischemia, which contribute to the progression of dystrophy processes and direct generalized depressive effect on organs and systems.
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