The effect of epidural anaesthesia on peripheral resistance and graft flow following femorodistal reconstruction

Abstract

Epidural anaesthesia significantly decreases peripheral resistance and increases graft blood flow in femorocrural grafts and would appear, therefore, to be of benefit for patients undergoing femorodistal reconstruction.

Sequential Compression Biomechanical Device Versus Primary Amputation in Patients With Critical Limb Ischemia

“…These findings contradict the traditional assumption that arterioles in patients with CLI are thought to be ''maximally dilated'' due to peripheral sympathetic autoregulation that is considered abolished in CLI (a phenomenon known as vasomotor paralysis), and they are relatively insensitive to vasodilator stimuli. 12,32 Yet, epidural anesthesia 33 and the administration of prostaglandins, 34,35 both causing attenuation of peripheral flow resistance with vasodilatation, have been reported to offer an appreciable clinical improvement thus contradicting the contention of peripheral vasoparalysis in CLI.…”

Effects of epidural-and-general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb

“…Previous studies (13,15,(25)(26)(27)(28)(29) have examined the arterial flow dynamics of the lower extremity during different types of surgery, including prostatectomy (13,28) elective total abdominal hysterectomy and uterine myomectomy (25), femoropopliteal, femorocrural (15,27,29) and aortofemoral reconstructions (29), total hip arthroplasty (26) and inguinal hernia repair (27). These studies, three of which were randomized (26)(27)(28), using different techniques, such as 133 Xe clearance (29), radio-actively ( 99 mTc) labeled erythrocytes in whole body scintigraphy (30), ankle brachial indices (31) venous occlusion impedance plethysmography (13,(25)(26)(27)(28), electromagnetic flowmetry (15,29), laser Doppler flowmetry (27), and Doppler ultrasound (11,13,17), indicated that implementation of EA generated a significant enhancement of the arterial leg inflow contrasting the flow attenuation sustained with GA. Yet, extensive literature review revealed only one study on the effects of EA on the venous hemodynamics of the leg (17), based on a long outdated Doppler (1983) methodology.…”

“…The highly significant effect of EA in reducing the risk of DVT (odds ratio 0.56; 95% CI 0.43-0.72) and pulmonary embolism (odds ratio 0.45; 95% CI 0.29-0.69) (1, 3-5) has been associated with a better preservation of fibrinolytic activity (6,7), an inhibitory action on platelet aggregation (8), thrombo-elastographic evidence of decreased platelet-fibrinogen interaction particularly in arteriopaths (9), and a stabilising effect on leucocytes and endothelial cells (10), linked to a hyperkinetic blood flow in the lower limbs (11)(12)(13)(14)(15)). Yet, the venous hemodynamics associated with the administration of EA particularly as part of GA in abdominal surgery have remained largely undetermined despite their being antithetical to the phenomenon of peri-operative venous stasis.…”

Vascular Reconstruction in Buerger's Disease: Is it Feasible?

“…Epidural anesthesia is associated with a reduction in the blood viscosity 16 and an increased graft flow, 17 and therefore is considered to be the method of choice for these procedures. Since there are many studies showing the beneficial effects of epidural anesthesia in patients with vascular diseases of the lower limb, this form of anesthesia is preferred.…”