Background: Acute limb ischemic is a disease that threatens the viability of the leg with the threat of amputation to death. Fast and accurate diagnosis is essential in the management of this disease, one of the most commonly performed surgical therapies in Indonesia is thromboembolectomy using a Fogarty catheter. Thromboembolectomy with this method is very effective but gives a variety of complications, one the complication is the occurrence of intima hyperplasia which affects the lumen restenosis of the blood vessels. The aim of this study is to determine whether the administration of oral L-Arginine as a supplement for 4 weeks after endothelial trauma with a Fogarty embolectomy balloon catheter can prevent the incidence of intimal hyperplasia of the iliac artery of the New Zealand Rabbit (Cuniculus oryctolagus).Methods: Experimental study with 16 experimental animals of Oryctolagus cuniculus rabbits subjected to endothelial trauma with Fogarty catheters and divided into 2 groups. The control group was not given L-Arginine and the experimental group was given post-treatment oral L-Arginine for 4 weeks, then the intima-media ratio was compared with histopathological examination.Results: There was a significant difference in the ratio of intima-media thickness between the control group (without L-Arginine administration) 5.13 ± 4.12 and the experimental group (with L-Arginine administration) 1.18 ± 0.59 (p=0.03 ). Significant differences were also found in the intima thickness of the control group 302.22 ± 217.42 and the experimental group 118.21 ± 32.59 (p=0.048). Meanwhile, for the thickness of the tunica media and the intima-media complex, there were no significant differences observed.Conclusion: Administration of L-Arginine orally after endothelial trauma with Fogarty catheter in rabbit iliac artery significantly reduces the degree of intima hyperplasia.

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Background: Temporary abdominal aortic cross-clamping is often applied as an adjunct procedure to control bleeding in patients with placenta accreta spectrum during cesarean hysterectomy. It is claimed to reduce the blood loss need for transfusion and improve visualization of the operating field. After the cross-clamp is removed, the tissue distal to the occlusion, which was initially in an ischemic state, gets a sudden blood flow causing ischemia-reperfusion injury due to the release of ROS. Transdermal administration of carbon dioxide is expected to reduce the release of ROS through the Bohr Effect to protect against ischemia-reperfusion injury, which can be seen from the level of malondialdehyde. Method: This experimental study recruited all patients with placenta accreta spectrum who underwent temporary abdominal aortic cross-clamping during cesarean hysterectomy from January to June 2022. Subjects were divided into control groups and treatment groups. The treatment group was given transdermal CO2 immediately after the aortic cross-clamp was removed. The plasma MDA levels were examined before and after aortic cross-clamping. Results: The number of subjects in each group was 7 subjects. There was an increase in MDA levels from 19.779+0.870nmol/ml to 21.104+1.053nmol/ml after cross-clamp in all groups, with an average increase of 1.325+0.801nmol/ml (p=0.00). The treatment group that received transdermal CO2 had a lower tendency to increase MDA levels, 1.063+0.803nmol/ml, compared to the control group at 1.586+0.766nmol/ml. Conclusion: There was an increase in MDA levels as a predictor of ischemia-reperfusion injury in patients undergoing temporary abdominal aortic cross-clamping. The administration of transdermal CO2 tends to suppress ischemia-reperfusion injury.

BACKGROUND: Finding the optimum vascular grafts (VG) to replace damaged blood arteries in cardiac surgery is still a work in progress. To be employed, a tissue-engineered VG (TEVG) must have the appropriate biological and mechanical qualities. Decellularized arteries may be a better TEVG than synthetic grafts because of their natural three-dimensional architecture. AIM: The goal of this study was to compare different concentrations and times of sodium dodecyl sulfate (SDS) to decellularize tissue to find the best decellularized VG. METHODS: In all decellularized scaffolds, which are 1% SDS-2 weeks group, hematoxylin and eosin and Masson’s trichrome staining exhibited looser collagen networks and fewer nuclei. RESULTS: The orientation of collagen fibers was identical to native vascular scaffolds. Collagen I deposition was seen in the immunohistochemistry assay. A tensile strength test revealed that the decellularized scaffold (0.5% SDS for 4 weeks and 0.5% SDS for 2 weeks) had exceeded the native arteries’ maximal strength. In comparison to 1% SDS in 4 weeks treated groups, scanning electron microscopy following decellularization revealed no endothelial cells on the inner side of 1% SDS in 2 weeks group with minimum extracellular matrix damage. The endothelial cells remained marginally visible on the inner side of all 0.5% SDS treated groups. The 3-(4,5-dimethylthiazol-2yl)2,5-diphenyltetrazolium bromide test was used to determine the cytotoxicity of the decellularized scaffolds. CONCLUSION: This study reveals that exposing a bovine mesenteric artery to 1% SDS for 2 weeks is an excellent procedure for extracting the most acellular VG, potentially serving as a biological scaffold for TEVGs.