Design of a New Risk Score in Critical Limb Ischaemia: The ERICVA Model.

OBJECTIVES: It is difficult to establish which patients suffering from critical lower limb ischaemia will benefit from revascularization. Risk scores can provide objectivity in decision making. The aim was to design a new risk score (ERICVA) and compare its predictive power with the PREVENT III and Finnvasc scores. METHODS: An observational retrospective study of patients who underwent revascularization (open or endovascular) in Valladolid's University Hospital between 2005 and 2010 was designed. The sample was divided into two subgroups (development and validation subsamples). After univariate analysis followed by a multivariate Cox regression, a number of variables associated with death and/or major amputation were selected, creating a weighed score called ERICVA, and a simplified version of it. The area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis was performed and the AUC of these two scores were additionally compared with the AUC of the PREVENT III and Finnvasc scales. RESULTS: Six hundred and seventy two cases with an average surveillance of 778 days were included in the study. Amputation free survival (AFS) was 84.8% at 30 days and 63.1% at 1 year. Variables associated with death and/or major amputation in the Cox regression were cerebrovascular disease, prior contralateral major amputation, diabetes mellitus, dialysis, chronic obstructive pulmonary disease, cancer, haematocrit less than 30%, neutrophil/lymphocyte ratio exceeding 5, absence of arterial Doppler signal at the ankle, emergency admission, and Rutherford stage 6; these variables were used for the ERICVA and simplified ERICVA score designs. Scores were applied to both subsamples; in the development sample the AUC of ERICVA and simplified ERICVA was significantly higher than the PREVENT III (p = .008 and p = .045) and Finnvasc (p < .0001 and p = .0013) scores; in the validation sample the AUC of ERICVA and simplified ERICVA were significantly higher than Finnvasc score (p = .0323 and p = .0017). CONCLUSIONS: The ERICVA model has a good predictive capacity for death and/or major amputation in the clinical setting, and is better than the PREVENT III and Finnvasc scores.

Role of calcifying nanoparticle in the development of hyperplasia and vascular calcification in an animal model.

OBJECTIVE: Calcifying nanoparticles (NPs) have been detected recently in calcified human arterial specimens and are involved in the process of calcification. This study was designed to test the hypothesis that human-derived NPs could worsen the response to arterial endothelial injury and induce vascular calcification. METHODS: The right carotid artery of 24 New Zealand rabbits was injured with an angioplasty balloon. Animals were perfused intravenously with saline (100 mL) during the experiment and divided into three groups: group-A, control; group-B, exposed to NPs (2 mL) obtained from calcified aortic valves; and group-C, exposed to NPs (2 mL) and treated postoperatively with atorvastatin (2.5 mg/kg/24 h). At 30 days, both carotid arteries were removed and examined histologically. Blood measurements were monitored during the study. RESULTS: The intimal hyperplasia area was significantly larger in the injured right carotid artery compared with the left unoperated carotid artery in all groups. There was no significant variation in medial area between groups. Morphometrically, the intima/media ratio (IMR) was significantly higher in damaged carotids compared with controls. A significant increase of IMR was found in group-B (1.81 ± 0.41) compared with group-A (0.38 ± 0.59; p = .004) or group-C (0.89 ± 0.79; p = .035). Differences between groups C and A were not significant (p = .064). Calcifications were observed in six animals, all of which had been exposed to NPs (4 in group-B, 2 in group-C, p = .027). Plasma levels of cholesterol and triglycerides remained stable. CONCLUSIONS: This research confirms the ability of systemic inoculation of human-derived NPs to accelerate hyperplasia and stimulate calcification in localized areas of arteries previously submitted to endothelial damage, while it was harmless in healthy arteries. Atorvastatin was demonstrated to slow down this process.

Percutaneous treatment of liver failure and acute mesenteric ischaemia.

INTRODUCTION: Synchronous embolism to the superior mesenteric artery (SMA) and coeliac axis (CA) is a rare disease. REPORT: A 67-year-old man with atrial fibrillation developed acute liver failure due to an embolic occlusion of the CA and SMA, with a severe coagulation disorder. He was successfully managed with percutaneous stent placement and an exploratory laparotomy was not needed. He remains symptom-free 1 year after the procedure, and duplex follow-up showed stent patency. CONCLUSION: Endovascular techniques in patients with liver failure, no signs of peritonism, early diagnosis and high operative risk seem feasible and should be used if possible, as first-line option.

[Prognosis of patients with COVID-19 presenting acute ischaemic stroke and receiving interventional treatment]. / Pronóstico de pacientes COVID-19 con ictus isquémico y tratamiento neurointervencionista.

Objetivo: Presentar nuestra experiencia y analizar el pronóstico de pacientes COVID-19 con ictus isquémico agudo por oclusión de grandes vasos tratados con neurointervencionismo (NIV) en la unidad de ictus. Material y métodos: Se incluyeron todos los pacientes consecutivos con ictus isquémico agudo debido a oclusión de grandes vasos tratados por NIV en nuestra institución entre marzo y abril de 2020, durante el brote de COVID-19. Se realizó una comparación entre pacientes con COVID-19 y pacientes sin infección por coronavirus. Se comunican los resultados clínicos iniciales y a corto plazo. Resultados: Del 1 de marzo al 30 de abril se realizaron 25 procedimientos de NIV por ictus isquémico agudo en nuestra institución. Ocho pacientes eran COVID-19 y 17 eran pacientes no COVID-19. La edad media de los pacientes con COVID-19 fue de 70,1 ± 12,23 años, y 7 fueron hombres (87,5%, p = 0,006). Mientras que todos los pacientes sin COVID procedían de urgencias, solo 5 pacientes con COVID-19 (62,5%) fueron atendidos desde urgencias por ictus (p = 0,01). Tres pacientes procedían de hospitalización. La tasa de mortalidad en pacientes sin COVID-19 fue del 5,8%, pero en pacientes con COVID-19 fue considerablemente alta (50%). Ningún parámetro analítico difirió entre ambos grupos. No se registraron hemorragias en esta serie.En comparación con el mismo período del año pasado, se observó una disminución de la actividad neurointervencionista del 39%. Conclusiones: La mejor terapia médica y de NIV desembocó en malos resultados y una mortalidad dramática. La pandemia de COVID-19 dificultó significativamente el funcionamiento normal de los servicios de urgencias y la atención de estos pacientes con ictus.

Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery.

OBJECTIVE: To compare the outcome of the postoperative administration of a restricted or standard intravenous fluid regimen in patients who underwent elective abdominal vascular surgery. The primary end point was postoperative hospital stay. DESIGN: Prospective observer-blinded, randomised controlled trial. MATERIAL AND METHODS: Patients were considered eligible if they underwent transperitoneal aorto-iliac approach with infrarenal graft repair. During the operation and intensive care unit stay, fluids were prescribed by the anaesthetists who were unaware of the details of the study. In the vascular surgical ward, patients in the standard group (SG) received 2500ml of fluids per day, whereas patients in the restricted group (RG) received 1500ml of fluids per day. All the patients were evaluated on an intention-to-treat basis. RESULTS: Forty patients were randomised to the RG (n=20) or SG (n=20). No significant differences were observed in the recovery of gastrointestinal function. However, the postoperative hospital stay was shorter in the RG (8 days) than in the SG (12 days) (p=0.003). CONCLUSIONS: The use of a restrictive postoperative fluid protocol significantly reduces the duration of hospital stay in patients who have undergone major elective abdominal vascular surgery.

Varicose veins show enhanced chemokine expression.

OBJECTIVES: Leucocyte infiltration in the wall of varicose veins has been reported previously. This study was designed to investigate the expression of pro-inflammatory cytokines and chemokines in control and in patients with varicose veins and to test the effect of treating varicose vein patients with acetylsalicylic acid (ASA) on cytokine expression prior to removal of varices. MATERIAL AND METHODS: Sections of vein were removed during operation from both patient groups, and ribonuclease protection assays (RPAs) were performed to assess the expression of chemokines. Group I included non-varicose saphenous veins from healthy patients undergoing amputation for trauma. Varicose veins were obtained from patients with primary varicose undergoing surgical treatment who received no drug (group II) or treatment with 300 mg day(-1) of ASA for 15 days before surgery (group III). RESULTS: Non-varicose veins constitutively expressed low levels of monocyte-chemoattractant protein (MCP-1) and interleukin (IL)-8 mRNA. Varicose veins had a distinct chemokine expression pattern, since significant up-regulation of MCP-1 and IL-8 and a marked expression of IP-10, RANTES, MIP-1alpha and MIP-1beta mRNA were detected. Removal of the endothelium did not alter this pattern. Varicose veins obtained from patients treated with ASA showed a consistent decrease in chemokine expression, although it did not reach statistical significance. CONCLUSIONS: Varicose veins showed increased expression of several chemokines compared to control veins. A non-significant reduction of activation was observed following treatment with ASA for 15 days.

Hemodynamic and cerebral repercussions arising from surgical interruption of the superior vena cava. Experimental model.

This study was designed to analyze the hemodynamic and cerebral repercussions arising from the surgical interruption of the superior vena cava. The experiments were carried out in 12 mongrel dogs under two different conditions: with shunt (group A, n = 6) and without the installation of a shunt (group B, n = 6). The period of occlusion was 35 minutes. The right atrium pressure, pulmonary arterial pressure, and aortic pressure are not significantly modified in the two groups. The intracranial pressure had an important correlation with the central venous pressure (r2 = 0.8572). In group B, the intracranial pressure had a sharp increase between the basal period (6.9 +/- 1.47 mm Hg) and the clamping superior vena cava (17.2 +/- 1.05 mm Hg), accentuated with the interruption of the azygous vein (32.2 +/- 0.7 mm Hg). In group A, the use of a shunt avoided this alteration during clamping of the superior vena cava (6.8 +/- 2.0 mm Hg) and the azygous vein (8.0 +/- 2.24 mm Hg). However, after removal of the clamps in group B, an elevated residual intracranial pressure was observed (21.1 +/- 3.33 mm Hg) in contrast to the central venous pressure, which returned to the basal values (4.4 +/- 0.7 mm Hg). The biomechanic findings of the volume-pressure curves (with Miller and Marmarou-Shapiro tests) and the cerebral necropsy showed brain damage in group B, without the shunt. Three animals had areas of hemorrhagic infarction. Histologic study demonstrated signs the incipient vasogenic edema. In group A, all findings were compatible with the normal. In conclusion, these results suggest the importance of shunting the blood in those cases of a nonobstructed superior vena cava because the clamping and reconstruction produce hemodynamic compromise and brain damage.

Saphenous vein patch versus polytetrafluoroethylene patch after carotid endarterectomy.

Although carotid patch angioplasty has been performed on a selective or routine basis in all large series of carotid endarterectomy, the choice of patch material still remains in question. The objective of this study has been a prospective randomized evaluation of the relative risks and benefits of saphenous vein patch versus PTFE patch material for carotid endarterectomy. During a 4-year period, 84 patients undergoing 95 carotid endarterectomies were randomized into two groups: 45 venous patch (n = 40) and 50 PTFE patch (n = 44). All operations were carried out under general anesthesia and systematic placement of a shunt. The patients were evaluated at 1, 3, 6 months and every year with doppler, periorbitary photoplethysmography, intravenous digital subtraction angiography, and neurologic assessment (mean follow-up 29 +/- 1 month). Operative time among patients having PTFE patch was significantly longer (p < 0.05) than among those having saphenous vein patch, due to bleeding from suture holes. Perioperatively, no neurologic complications or deaths were observed in venous patch patients, however there was a permanent stroke and one death from arterial wall disruption in the PTFE patch group. The incidence of aneurysmal dilatation in the saphenous vein patch group (15.5%) was higher than for the PTFE patch group (2%). On late follow-up, no deaths, carotid thrombosis or patch rupture were observed in either group. Recurrent stenosis occurred in 2 cases having PTFE patch. One reoperation for recurrence was required. In addition, one patient with PTFE patch angioplasty developed an infected false aneurysm at 7 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Amaurosis fugax as a symptom of carotid artery stenosis. Its relationship with ulcerated plaque.

Amaurosis fugax has frequently been related to carotid artery disease. In order to determine the relationship between amaurosis fugax and significant carotid artery stenosis, we prospectively studied 81 consecutive patients presenting to an ophthalmologist with this symptom. Neurologic and vascular evaluation with PPG and Duplex-scan were performed. A stenosis of greater than 70% was regarded as significant. DSA was performed in patients with significant stenosis (55 of 81). The presence of risk factors such as hypertension, diabetes, coronary artery disease, tobacco and hyperlipidemia was considered. Mean age was 64.96 years. There was a high prevalence of hypertension, smoking and previous CVA/TIAs. Patients with significant carotid stenosis were endarterectomized. Carotid atheromata plaques were classified in three groups: hemorrhagic plaque (5), dystrophic calcification (8) and ulcerated plaque (42). There was a high correlation (0.87) between ulcerated plaque and amaurosis fugax. We conclude that amaurosis fugax is an important symptom to allocate patients with high risk of carotid disease, specially carotid stenosis complicated with ulcerated plaque. Carotid duplex scan must be done if this symptom is present.

Sartorius myoplasty for the treatment of infected groins with vascular grafts.

INTRODUCTION: Vascular graft infection is a rare (0.8-2.6%) but serious complication of reconstructive vascular surgery, that comprises limb-threatening when located in the groin. PURPOSE: Review our experience in the treatment of infected groin wounds after femoral surgery by using sartorius myoplasty. MATERIALS AND METHODS: Between January 1989 and October 1993, 13 patients with infected groin wounds involving vascular graft (Grade III of Szilagyi) were treated with local gently debridement, 10% povidone iodide lavage for 5 days, local and systemic antibodies for 14 days and in situ change of the infected graft followed by sartorius myoplasty, detaching its origin from superior anterior iliac spine and fixing it to inguinal ligament, except in one case where tissue cultures were negative and the graft was not changed. Follow-up was done using clinical and echographical criteria at 3, 6, 12 months after operation, and annually. RESULTS: Hospital mean stage was 10 days (8-13). The mean follow-up was 36 months (12-65). There was only one immediate complication from hemorrhage that needed surgery. The patient whose graft was not changed developed an abscess in the prosthetic bed 12 weeks after treatment. It was necessary to change it after debridement and antibiotics. No mortality was related to this technique. CONCLUSIONS: Sartorius myoplasty, with detaching and origin transposition, after in situ change of infected graft, is an excellent therapeutic option for reconstruction and treatment for infected groins with vascular grafts because it is easy to perform and offers very good results in long-term follow-up.

Lumbar sympathectomy as isolated technique for the treatment of lower limbs chronic ischemia.

BACKGROUND: Lumbar sympathectomy (LS) is often the only alternative treatment that can be considered as a means of improving the distal circulation to such extent that major amputation is prevented. To make a retrospective study in order to know the current value of LS as isolated technique for the treatment of severe ischemia of lower limbs in the absence of the possibility for vascular reconstruction. METHODS: Between 1987 and 1992, 100 LS were performed in 93 patients (82 males and 11 females) aged 64.5+/-11.1 yrs. 63% were older than 70 years. Indication was invalidant claudication/rest pain (grade II, 57%) or trophic lesion (grade III, 43%) in patients where previous reconstructive surgery failed (18%), was not possible to do (23%) or refused revascularization (20%), or with poor surgical risk (39%). Preoperative evaluation included Doppler measures, ankle/brachial index (ABI) and arteriography in every case. Surgical sympathectomy was performed in all patients. Success was considered if rest pain was absent or trophic lesions have healed at six months, comparing results in patients diabetics and non-diabetics with ABI higher or lower 0.3. RESULTS: Postoperative stage was 6.4+/-2.3 days. Morbidity was 4% and mortality was 7% in the 30-day postoperative period, related with patients older than 70 years. Long-term mortality was 9%, for a global nortality of 16%. 12 patients needed inflow surgery after LS. There was success in 58.5% of grade II and 61.7% of grade III patients at six months, with significative difference (p=0.049) if ABI was >0.3. In diabetics with ABI >0.3, trophic lesions have worse prognostic than ABI <0.3. Pre- and postoperative ABI were correlated (R2=0.65), and the increasing of 0.1 in preoperative ABI had a positive prognostic value over lesion healing. Patency of superficial femoral artery (SFA) has correlated significantly (p=0.000021) with successful outcome after LS. CONCLUSIONS: LS could be a technique that moderately improves the ischemic limb in patients who refuse major surgery or where arterial reconstruction is not indicated. Preoperative ABI has prognostic value in postoperative outcome, with clinical improvement if it is >0.3. Diabetes has not been a negative predictive factor in our series. Patency of superficial femoral artery is related to successful outcome of the patients.

Superficial femoral artery as a substitute for common carotid artery affected by malignant cervical tumors.

Tumoral disease of the arteries is uncommon. It is possible that, in tumoral reoperations affecting cervical structures, periarterial fibrosis due to radiotherapy and previous surgery and metastatic adherences to the arterial wall makes radical surgery difficult. We present a case where the surgical treatment of a regional relapse from laryngeal neoplasm needed the removal of the common carotid artery and its reconstruction with autologous patent superficial femoral artery. Surgical technique included a PTFE graft interposition in the leg.

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

Liposarcoma is a malignant tumor that has an embryologic origin from mesodermal tissue depending on fatty tissue. Although liposarcoma is only 0.1% of all human neoplasms, it is the most common histology subtype of retroperitoneal soft tissue sarcomas. This tumor grows slowly. Diffuse abdominal pain is its most frequent symptom and abdominal mass is the most common sign. Aggressive surgical treatment is basic to get a complete resection and a local disease control. This objective is difficult because of the large tumor size it gets in the retroperitoneal location and the multiorgan involvement that require the resection of a high percentage of contiguous organs. We report a case of a giant retroperitoneal liposarcoma presenting like continuous left hemiabdominal pain because of the visceral compression. The right kidney was involved and suffering from renal vessel enlargement without renal function. There is a high probability of microscopic residual disease and a good follow-up of the patients is necessary as well as an adjuvant radiation therapy in some cases.

[Etiologic considerations regarding superior vena cava syndrome]. / Consideraciones etiológicas sobre el síndrome de vena cava superior.

Literature review indicates a change in the etiological trends of the Superior Cava Syndrome. While during the first half of the twentieth century, aortic aneurysms, malignant tumors and mediastinitis were its main causes, nowadays talking about obstruction of the superior cava is the same than talking about obstruction secondary to a malignant cause (85-90%). Benign affections account for 10-15% and, among them, intravenous iatrogenic foreign bodies constitute a new chapter as cause of thrombosis. Given that small cells simplex carcinoma is the most common cause of SCS and given that benign processes or other chemosensitive tumors can be present, it is currently necessary to secure the histologic diagnosis before starting the treatment.

[Core and cutaneous thermal changes in the upper limb after anesthesia induction]. / Cambios térmicos centrales y cutáneos en el miembro superior después de la inducción anestésica.

OBJECTIVES: To describe and compare the core-cutaneous thermal and photoplethysmographic time-course effects after induction of general anesthesia with propofol, fentanyl and vecuronium. PATIENTS AND METHODS: We measured digital blood flow, core temperature and skin temperature in the upper limb (fingertip, forearm and upper arm) in 20 patients (10 men and 10 women, ASA-I) before anesthetic induction and 5, 10, 15 and 20 min after induction. Skin temperature changes were recorded with disposable thermocouples. Blood flow was recorded by digital photoplethysmography (PhPl) in the thumb. Anesthesia was provided without premedication, using propofol (3 mg.kg-1), fentanyl (0.1 mg) and vecuronium (0.1 mg.kg-1). After endotracheal intubation, anesthesia was maintained with oxygen-nitrous oxide and 0.1 mg of intravenous fentanyl at the tenth minute, without inhaled anesthetics. RESULTS: All patients showed intense, abrupt vasodilatation in the thumb with marked increases in PhPl (PhPl = 10.4 +/- 5.0 mV/V, at 5 min, p < 0.001) and fingertip temperature (TFingertip = 6.2 +/- 2.0 C, at 10 min, p < 0.001). However, skin temperature changes in the upper arm and forearm were moderate and slower (TForearm = 2.1 +/- 1.4 C, p < 0.01 and TUpper arm = 1.1 +/- 1.2 C, p < 0.01; at 20 min in both cases). A significant correlation was found only between PhPl and TFingertip (r = 0.55, p < 0.001). CONCLUSIONS: Anesthetic induction with propofol, fentanyl and vecuronium produces cutaneous vasodilatation in the upper limb unequally: the greatest increase in skin temperature occurs at the fingertip, while forearm and upper arm temperatures increase less. We think that skin vasodilatation in peripheral distal areas may play an important role in redistributing core heat during anesthesia.

Asymptomatic carotid stenosis in patients with intermittent claudication: epidemiological study.

AIM: The aim of this paper was to determine the prevalence of extracraneal carotid artery disease in patients with intermittent claudication, to describe classic cardiovascular risk factors in those with hemodynamically significant stenosis and to try to define subgroups at high risk, improving therefore the performance of non invasive testing. METHODS: A prospective descriptive study was conducted, with 146 patients reporting an intermittent claudication of the lower limbs and without a previous cerebrovascular event or carotid surgery. An ultrasonography examination was done. Risk factors were registed (smoking, dislipemia, arterial hypertension, diabetes mellitus), also ischemic cardiopathy and myocardial revascularization procedures. Univariate and multivariate analysis was made to define the variables associated with hemodynamically significant stenosis. RESULTS: Prevalence of hemodynamically significant stenosis was 23.2%. Smoking, dislipemia, arterial hypertension and diabetes mellitus were not significantly associated with carotid stenosis; 24.2% of patients affected of ischemic cardiopathy present a severe stenosis, and myocardial revascularization was a risk factor for carotid stenosis. CONCLUSION: Patients with claudication and ischemic miocardiopathy, especially when myocardial revascularization is needed, must be explored with carotid ultrasonography. In this patients, probably of hemodynamically significant carotid stenosis that requires treatment is more frequent.

[Computerized registry of patients with thromboembolic disease in Spain (RIETE): background, objectives, methods, and preliminary results]. / Registro informatizado de pacientes con enfermedad tromboembólica en España (RIETE): justificación, objetivos, métodos y resultados preliminares.

BACKGROUND: Venous thromboembolic disease (VTD) is a common and severe condition. Its anticoagulation-based treatment is not without complications and failures. OBJECTIVE: To create in Internet a broad database of patients with venous thromboembolic disease attended at spanish hospitals which might be helpful in the clinical practice. METHODS: Computerized registry of all incident cases of patients with objective diagnosis of VTD attended at 27 spanish hospitals since March, 1st, 2001. All data related to diagnosis, treatment and follow-up during at least a 3-month period were collected. RESULTS: Since March 1st to August 31st, 2001, 573 patients were included (399 with VTD, 108 with PE and 66 with VTD and PE). The mean age of patients was 65.8 years. 10.5 % of patients had at least one risk factor: 5.2% hypoprothrombinemia (< 50%), 3% history of recent hemorrhage, 1.8% creatinine higher than 3 mg/dl, 1.3% hemodynamic unstability, 1.1% pregnancy, and 1% thrombopenia lower than 60000 platelets/mm3. The three-month follow-up period was completed by 35.4% of patients, 21.8 % of them with events (death [4.7%], hemorrhage [12.5%], and VTD relapse [4.2%]). Hypoprothrombinemia was significantly associated with increased risk of complications and history of recent hemorrhage with relapse. CONCLUSIONS: It is feasible to create a database containing information on a relevant number of VTD patients, 10.5% of them with complications. Such information will allow its utilization at short-term for the decision-marking process, particularly for patients with complications.

Protective effect of a platelet-activating factor antagonist (WEB-2086) in postischemic renal failure.

The purpose of this study was to evaluate the renoprotective effect of a specific platelet-activating factor antagonist (WEB-2086) in an experimental model of normothermic renal ischemia. Twenty New Zealand white rabbits were studied for 2 days before and 24 hours after a 60-minute period of renal ischemia induced by bilateral clamping of the renal arteries. The animals were divided into two groups: a control group (group A; n = 10) and a treated group (group B; n = 10). In group A the urinary flow rate decreased significantly (from 0.098 +/- 0.008 ml/min to 0.029 +/- 0.005 ml/min) (p < 0.001) and there was a significant reduction in creatinine clearance (from 11.4 +/- 1.2 ml/min to 3.4 +/- 1.1 ml/min) (p < 0.001). In group B no significant changes were observed, although the urinary flow rate increased even in the postischemic period (from 0.09 +/- 0.008 ml/min to 0.11 +/- 0.02 ml/min). Microcirculatory cortical flow showed a postischemic reduction in both groups, although it was most significant in the control group (group A = 43.7%, group B = 71.5%; p < 0.001). Histologic study showed mild damage with patchy tubular necrosis in both groups, although this injury was less severe in the treated group. The results suggest that the preoperative administration of WEB-2086 produces a potent diuretic effect with significant attenuation of postischemic acute renal failure.