Distal Venous Arterialization and Reperfusion Injury: Focus on Oxidative Status

Abstract

In patients with unreconstructable arterial occlusive disease distal venous arterialization (DVA) seems to be a promising option in the treatment. The goals of this prospective study were to assess clinical efficiency and possible impact of DVA on tissue damage by estimating oxidative status of patients with critical limb ischemia treated with this procedure. The subjects were 60 randomized patients: 30 were undergoing DVA and 30 were treated with antiaggregation therapy. During the mean follow-up period (6.13 ± 4.32 months for DVA vs. 6.74 ± 0.5 months for antiaggregation therapy) survival (p < 0.01), limb salvage (p < 0.001), pain relief (p < 0.001) and wound healing (p < 0.001) rates were significantly different between the two groups of patients in favor of the DVA group. Ten minutes after declamping we observed a decreasing trend in the lactate level in the blood of the deep venous system (p < 0.001). Also, on postoperative day 7 digital systolic pressure and digital-brachial index were higher than before the operation (p < 0.001). In blood samples collected immediately before and successively at 1, 3, 5 and 10 min postoperatively, prooxidative status (thiobarbituric acid reactive substances, O₂^–, H₂O₂ and nitric oxide) and antioxidative enzymes (superoxide dismutase, catalase and glutathione reductase) were determined spectrophotometrically. Using the nonparametric Friedman test, we noted statistically nonsignificant differences (p > 0.05) in values of both prooxidative parameters and enzymes of the antioxidative defense system, before and successively at 1, 3, 5 and 10 min after operation. These results indicate that there was no statistically significant reperfusion injury after revascularization, which could have been expected after this surgical procedure, thus confirming its validity in these patients.

Treatment of Post-Revascularization Syndrome: brief communication

“…al., [8] indicates that there is no statistically significant reperfusion injury after this surgical procedure, confirming the validity in these patients because it achieved the therapeutically goal -adequate re-oxygenation of ischemic tissue.…”

“…The aim of the present review is to display the role of those treatments and their level of success, reporting the effective ones in reducing the extension of the injury caused by reperfusion and its aspects [1,2,3,5,6,7,8,11,12,13,15,16,17,18].…”

Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis

“…However, in the studies by Djoric et al 13% limb salvage was observed in those patients treated by conservative means, while 83% and 93% limb salvage was obtained in the venous arterialisation group. 15,16 These findings and the differences in limb salvage rates in the studies included here suggest that patient selection might be important. Unfortunately, there are no data robust enough to support any recommendation on how to appropriately select patients for either venous arterialisation or conservative treatment or amputation.…”

“…15,16,23 Four articles were comparative studies. 15,16,22,24 Three compared surgery with conservative treatment 15,16,22 and one compared venous arterialisation with pedal bypass. 24 The included and excluded studies are summarised in Table 1 and Table 2, respectively.…”

“…2), and the quality of five studies was moderate. 16,19,22,24,25 Blinding and prospective calculation of study size were never reported, and loss to follow-up was higher than 5% in two studies 20,21 and not reported in nine. 13e18,22e24,26 One study scored 0 on all items of the MINORS scoring scale.…”