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1.
Orv Hetil ; 164(32): 1256-1262, 2023 Aug 13.
Artículo en Húngaro | MEDLINE | ID: mdl-37573558

RESUMEN

With the growing number of patients with vascular endografts, the number of patients with graft infections has also increased. Septic conditions and the choice of grafts are an important challenge in vascular surgery. The aim of this study was to review the literature of the last 7 years showing allograft use in septic conditions in vascular surgery which helps provide insight into the current results of vascular allografts. Data were collected between 1st January 2016 and 31st December 2022. A systematic search was conducted for publications of cryopreserved allograft usage for vascular infection in PubMed and Medline databases. The results of the publications were reviewed based on the following key endpoints: study design, patient's characteristics, mortality rate, graft related complication and reintervention rate, graft patency, limb salvage, graft reinfection rate and survival rate. After a systematic search, 16 publications were included. The articles were divided into two groups: aortic and peripheral. The aortic group included 12 studies covering the data of 542 patients. Early mortality rate (<30 days) was between 2.8% and 42.8%. Allograft-related reintervention rates ranged between 5.9% and 29% (early and late). The rate of graft reinfection was below 10%. 4 studies were included in the peripheral group covering the data of 252 patients. Early mortality rate (<30 days) was between 2.0% and 38%. Allograft-related reintervention rates ranged between 4.0% and 55% (early and late). Reinfection rate was around 4%, but only poor quality data were available. Infections in vascular surgery remain a challenging problem, however, cryopreserved allografts show low reinfection rate and reasonable durability, thus, allografts may be an acceptable option for reconstruction. Orv Hetil. 2023; 164(32): 1256-1262.


Asunto(s)
Implantación de Prótesis Vascular , Infecciones Relacionadas con Prótesis , Humanos , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Reinfección/complicaciones , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/etiología , Resultado del Tratamiento , Aloinjertos/cirugía , Estudios Retrospectivos , Criopreservación
2.
PLoS One ; 17(10): e0275628, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36301873

RESUMEN

INTRODUCTION: Femoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15-45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI. AIMS: Our objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts. METHODS: Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017. RESULTS: During a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years. CONCLUSION: Allograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.


Asunto(s)
Isquemia , Enfermedad Arterial Periférica , Masculino , Humanos , Grado de Desobstrucción Vascular , Isquemia Crónica que Amenaza las Extremidades , Estudios Retrospectivos , Vena Safena/cirugía , Recuperación del Miembro , Aloinjertos , Resultado del Tratamiento , Factores de Riesgo
4.
PLoS One ; 16(7): e0255114, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34293054

RESUMEN

INTRODUCTION: Management of vascular infections represents a major challenge in vascular surgery. The use of cryopreserved vascular allografts could be a feasible therapeutic option, but the optimal conditions for their production and use are not precisely defined. AIMS: To evaluate the effects of cryopreservation and the duration of storage on the thrombogenicity of femoral artery allografts. METHODS: In our prospective study, eleven multi-organ-donation-harvested human femoral arteries were examined at five time points during storage at -80°C: before cryopreservation as a fresh native sample and immediately, one, twelve and twenty-four weeks after the cryopreservation. Cross-sections of allografts were perfused with heparin-anticoagulated blood at shear-rates relevant to medium-sized arteries. The deposited platelets and fibrin were immunostained. The thrombogenicity of the intima, media and adventitia layers of the artery grafts was assessed quantitatively from the relative area covered by fibrin- and platelet-related fluorescent signal in the confocal micrographs. RESULTS: Regression analysis of the fibrin and platelet coverage in the course of the 24-week storage excluded the possibility for increase in the graft thrombogenicity in the course of time and supported the hypothesis for a descending trend in fibrin generation and platelet deposition on the arterial wall. The fibrin deposition in the cryopreserved samples did not exceed the level detected in any of the three layers of the native graft. However, an early (up to week 12) shift above the native sample level was observed in the platelet adhesion to the media. CONCLUSIONS: The hemostatic potential of cryopreserved arterial allografts was retained, whereas their thrombogenic potential declined during the 6-month storage. The only transient prothrombotic change was observed in the media layer, where the platelet deposition exceeded that of the fresh native grafts in the initial twelve weeks after cryopreservation, suggesting a potential clinical benefit from antiplatelet therapy in this time-window.


Asunto(s)
Aloinjertos/patología , Arterias/trasplante , Criopreservación , Trombosis/patología , Adulto , Aloinjertos/trasplante , Aloinjertos/ultraestructura , Arterias/ultraestructura , Plaquetas/metabolismo , Femenino , Fibrina/metabolismo , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Adhesividad Plaquetaria , Factores de Tiempo
5.
Orv Hetil ; 160(31): 1231-1234, 2019 Aug.
Artículo en Húngaro | MEDLINE | ID: mdl-31352805

RESUMEN

Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231-1234.


Asunto(s)
Implantación de Prótesis Vascular/métodos , Prótesis Vascular/efectos adversos , Cateterismo Venoso Central/efectos adversos , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Anciano , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares , Femenino , Humanos , Hungría , Fallo Renal Crónico/diagnóstico , Diseño de Prótesis , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular
6.
Orv Hetil ; 159(13): 520-525, 2018 Apr.
Artículo en Húngaro | MEDLINE | ID: mdl-29577761

RESUMEN

INTRODUCTION AND AIM: Iliac artery aneurysms make up 2% of all aneurysms. There are only a few data available on the results of surgical treatment, therefore the optimal treatment is unclear. Our objective was the retrospective analysis of the perioperative morbidity and mortality of patients who underwent iliac artery surgery as well as the comparison of elective open surgery and endovascular iliac aneurysm repair (EVIAR). METHOD: Retrospective analysis of patients who underwent surgery for iliac artery aneurysm between 1 January 2005 and 31 December 2014. RESULTS: During the 10-year period, 62 patients with a mean age of 68.9 years underwent elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within the perioperative period (30%). Regarding anatomical localisation, aneurysm developed mostly on the common iliac artery (80.6%). As an elective surgery, 35 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other endovascular interventions were performed in 2 cases (3.2%). Postoperative complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001) were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no significant differences regarding long-term survival rates between EVIAR and open surgery (81.4% vs. 71.4%; p = 0.95). CONCLUSION: In case of the surgical treatment of iliac artery aneurysms, owing to the lower complication rates and shorter postoperative length of stay, EVIAR is primarily recommended. Orv Hetil. 2018; 159(13): 520-525.


Asunto(s)
Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Procedimientos Endovasculares/métodos , Aneurisma Ilíaco/cirugía , Arteria Ilíaca/cirugía , Anciano , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Aneurisma Ilíaco/patología , Arteria Ilíaca/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos
7.
Magy Seb ; 70(1): 5-12, 2017 03.
Artículo en Húngaro | MEDLINE | ID: mdl-28294663

RESUMEN

INTRODUCTION: Vascular homografts are used for limb salvage in cases of graft infection after previous reconstructive vascular surgery or inadequate autologous veins. During multi-organ donation the thoracic aorta segment, aortic bifurcation, iliac arteries, femoral arteries, popliteal arteries, femoral veins and greater saphenous veins can be harvested. Our aim was to optimize the use of homografts by analyzing the results of previous procedures. METHODS: The patient information was processed retrospectively, using the clinical computer system. 162 procedures were performed on 144 patients between 2007 and 2014. The short- and long-term patency, hemorrhagic complication rate, amputation rate and mortality was examined in our study. The location, graft type and length of cryopreservation were taken into consideration. Aortoiliac and femoropopliteal reconstructions with arterial and venous homografts were examined. RESULTS: The mean age of the patients was 63.6 ± 10.7 years, the mean follow-up period was 36 ± 28 months. The primary patency rates at the postoperative 1, 3 and 6 months were 83.7%, 75.0% and 63.4%. In this study the arterial and deep venous homografts had better primary patency rates compared to the superficial venous homografts: at the postoperative 1, 3, 6 months the arterial homograft results were 85.6%, 78.6% and 74.3%, the greater saphenous vein homograft results were 81.4%, 70.4% and 47.7% in the same intervals. CONCLUSION: The reconstructive surgical procedures in septic area mean serious challenge for the vascular surgeons. The AB0 compatibility of the graft and the recipient did not result better long-term outcomes compared to the non-compatible grafts. According to our data the ideal choice of homogenous graft is an arterial homograft which was not cryopreserved longer than 6 months.


Asunto(s)
Arterias/cirugía , Arterias/trasplante , Prótesis Vascular/efectos adversos , Pierna/irrigación sanguínea , Trasplante Homólogo , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Criopreservación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Resultado del Tratamiento , Grado de Desobstrucción Vascular
8.
J Transl Med ; 13: 21, 2015 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-25622967

RESUMEN

BACKGROUND: Postconditioning is a novel reperfusion technique to reduce ischemia-reperfusion injuries. The aim of the study was to investigate this method in an animal model of lower limb revascularization for purpose of preventing postoperative renal failure. METHODS: Bilateral lower limb ischemia was induced in male Wistar rats for 3 hours by infrarenal aorta clamping under narcosis. Revascularization was allowed by declamping the aorta. Postconditioning (additional 10 sec reocclusion, 10 sec reperfusion in 6 cycles) was induced at the onset of revascularization. Myocyte injury and renal function changes were assessed 4, 24 and 72 hours postoperatively. Hemodynamic monitoring was performed by invasive arterial blood pressure registering and a kidney surface laser Doppler flowmeter. RESULTS: Muscle viability studies showed no significant improvement with the use of postconditioning in terms of ischemic rhabdomyolysis (4 h: ischemia-reperfusion (IR) group: 42.93 ± 19.20% vs. postconditioned (PostC) group: 43.27 ± 27.13%). At the same time, renal functional laboratory tests and kidney myoglobin immunohistochemistry demonstrated significantly less expressed kidney injury in postconditioned animals (renal failure index: 4 h: IR: 2.37 ± 1.43 mM vs. PostC: 0.92 ± 0.32 mM; 24 h: IR: 1.53 ± 0.45 mM vs. PostC: 0.77 ± 0.34 mM; 72 h: IR: 1.51 ± 0.36 mM vs. PostC: 0.43 ± 0.28 mM), while systemic hemodynamics and kidney microcirculation significantly improved (calculated reperfusion area: IR: 82.31 ± 12.23% vs. PostC: 99.01 ± 2.76%), and arterial blood gas analysis showed a lesser extent systemic acidic load after revascularization (a defined relative base excess parameter: 1(st) s: IR: 2.25 ± 1.14 vs. PostC: 1.80 ± 0.66; 2(nd) s: IR: 2.14 ± 1.44 vs. PostC: 2.44 ± 1.14, 3(rd) s: IR: 3.99 ± 3.09 vs. PostC: 2.07 ± 0.82; 4(th) s: IR: 3.28 ± 0.32 vs. PostC: 2.05 ± 0.56). CONCLUSIONS: The results suggest a protective role for postconditioning in major vascular surgeries against renal complications through a possible alternative release of nephrotoxic agents and exerting a positive effect on hemodynamic stability.


Asunto(s)
Poscondicionamiento Isquémico , Insuficiencia Renal/etiología , Insuficiencia Renal/prevención & control , Procedimientos Quirúrgicos Vasculares/efectos adversos , Animales , Proteínas del Choque Térmico HSP72/metabolismo , Hemodinámica , Inmunohistoquímica , Corteza Renal/irrigación sanguínea , Corteza Renal/patología , Corteza Renal/fisiopatología , Pruebas de Función Renal , Flujometría por Láser-Doppler , Peroxidación de Lípido , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/fisiopatología , Masculino , Microcirculación , Músculos/patología , Mioglobina/metabolismo , Ratas Wistar , Insuficiencia Renal/fisiopatología , Daño por Reperfusión/prevención & control
9.
PLoS One ; 9(6): e101067, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24968303

RESUMEN

INTRODUCTION: Operation on the infrarenal aorta and large arteries of the lower extremities may cause rhabdomyolysis of the skeletal muscle, which in turn may induce remote kidney injury. NIM-811 (N-metyl-4-isoleucine-cyclosporine) is a mitochondria specific drug, which can prevent ischemic-reperfusion (IR) injury, by inhibiting mitochondrial permeability transition pores (mPTP). OBJECTIVES: Our aim was to reduce damages in the skeletal muscle and the kidney after IR of the lower limb with NIM-811. MATERIALS AND METHODS: Wistar rats underwent 180 minutes of bilateral lower limb ischemia and 240 minutes of reperfusion. Four animal groups were formed called Sham (receiving vehicle and sham surgery), NIM-Sham (receiving NIM-811 and sham surgery), IR (receiving vehicle and surgery), and NIM-IR (receiving NIM-811 and surgery). Serum, urine and histological samples were taken at the end of reperfusion. NADH-tetrazolium staining, muscle Wet/Dry (W/D) ratio calculations, laser Doppler-flowmetry (LDF) and mean arterial pressure (MAP) monitoring were performed. Renal peroxynitrite concentration, serum TNF-α and IL-6 levels were measured. RESULTS: Less significant histopathological changes were observable in the NIM-IR group as compared with the IR group. Serum K+ and necroenzyme levels were significantly lower in the NIM-IR group than in the IR group (LDH: p<0.001; CK: p<0.001; K+: p = 0.017). Muscle mitochondrial viability proved to be significantly higher (p = 0.001) and renal function parameters were significantly better (creatinine: p = 0.016; FENa: p<0.001) in the NIM-IR group in comparison to the IR group. Serum TNF-α and IL-6 levels were significantly lower (TNF-α: p = 0.003, IL-6: p = 0.040) as well as W/D ratio and peroxynitrite concentration were significantly lower (p = 0.014; p<0.001) in the NIM-IR group than in the IR group. CONCLUSION: NIM-811 could have the potential of reducing rhabdomyolysis and impairment of the kidney after lower limb IR injury.


Asunto(s)
Lesión Renal Aguda/etiología , Ciclosporina/farmacología , Extremidad Inferior/cirugía , Proteínas de Transporte de Membrana Mitocondrial/antagonistas & inhibidores , Daño por Reperfusión/complicaciones , Rabdomiólisis/complicaciones , Rabdomiólisis/etiología , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/patología , Animales , Biomarcadores/sangre , Biomarcadores/metabolismo , Supervivencia Celular , Ciclosporina/administración & dosificación , Modelos Animales de Enfermedad , Hemodinámica , Interleucina-6/sangre , Interleucina-6/metabolismo , Pruebas de Función Renal , Masculino , Microcirculación , Poro de Transición de la Permeabilidad Mitocondrial , Fibras Musculares Esqueléticas/metabolismo , Fibras Musculares Esqueléticas/patología , Ratas , Daño por Reperfusión/metabolismo , Rabdomiólisis/tratamiento farmacológico , Rabdomiólisis/patología , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/metabolismo
10.
Biomed Res Int ; 2014: 210901, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24955347

RESUMEN

UNLABELLED: Mesenteric ischemia-reperfusion (IR) is associated with impairment of the gut barrier function and the initiation of a proinflammatory cascade with life-threatening results. Therefore methods directed to ameliorate IR injury are of great importance. We aimed at describing the effects of postconditioning (PC) on the alterations of the intestinal mucosal function and the inflammatory response upon mesenteric IR. METHODS: Male Wistar rats were gavaged with green fluorescent protein-expressing E. coli suspensions. Animals were randomized into three groups (n = 15), sham-operated, IR-, and PC-groups, and underwent 60 minutes of superior mesenteric artery occlusion, followed by 6 hours of reperfusion. Postconditioning was performed at the onset of reperfusion. Blood and tissue samples were taken at the end of reperfusion, for histological, bacteriological, and plasma examinations. RESULTS: The PC-group presented a more favorable claudin-2, claudin-3, claudin-4, and zonula occludens-1 membrane expression profile, and significantly lower rates of bacterial translocation to distant organs and plasma D-lactate levels compared to the IR-group. Histopathological lesions, plasma I-FABP, IL-6, and TNF- α levels were significantly lower in the PC-group compared to the IR-group. CONCLUSION: The use of postconditioning improved the integrity of the intestinal mucosal barrier upon mesenteric IR, and thus reduced the incidence of bacterial translocation and development of a systemic inflammatory response.


Asunto(s)
Mucosa Intestinal/metabolismo , Poscondicionamiento Isquémico , Isquemia Mesentérica/sangre , Daño por Reperfusión/metabolismo , Animales , Escherichia coli/patogenicidad , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Isquemia Mesentérica/microbiología , Isquemia Mesentérica/patología , Oclusión Vascular Mesentérica , Ratas , Daño por Reperfusión/microbiología , Daño por Reperfusión/patología
11.
J Invest Surg ; 27(5): 282-90, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24830403

RESUMEN

PURPOSE/AIM OF THE STUDY: Long-lasting lower limb arterial occlusion is a condition with high incidence and complication rates. With the absence of appropriate treatment to cure advanced complications, mortality rates are high. Postconditioning (PC) might be capable of limiting the degree of ischemic-reperfusion (IR) injuries, thus reducing complications and mortality rates. The aim of this study was to evaluate the impact of postconditioning during the first postoperative day on skeletal muscle after a long-lasting arterial occlusion. MATERIALS AND METHODS: Male Wistar rats (n = 72) underwent 8 hr of infrarenal aortic occlusion followed by 2, 6, 12, or 24 hr of reperfusion. In one group of each reperfusion period, postconditioning was applied. Muscle samples were collected for histological examinations. Furthermore, muscle fiber viability and muscle wet-to-dry ratio were assessed. Blood samples were taken for creatine-kinase measurements. RESULTS: Postconditioning strongly reduced morphological injury compared to the corresponding ischemic-reperfusion group (p < .001). Serum creatine-kinase levels showed a peak at 6 hr post-ischemia (IR: 6702.2 ± 797.5; PC: 5523.3 ± 769.3 IU/l) and decreased to normal level by the end of the experiment (Sham: 171.5 ± 71.6; IR: 186.2 ± 82.7; PC: 174.2 ± 72.4 IU/l). Creatine-kinase levels were significantly reduced by postconditioning (p2hr = .028; p6hr = .06; p12hr = .042). A marked decrease in viability was observed in the ischemic-reperfusion groups (2 hr: 11.0 ± 4.1; 6 hr: 10.3 ± 3.6; 12 hr: 9.4 ± 3.3; 24 hr: 8.6 ± 2.8%), whereas with postconditioning, viability was preserved (2 hr: 26.4 ± 5.5; 6 hr: 24.6 ± 4.5; 12 hr: 24.5 ± 6.8; 24 hr: 26.2 ± 6.1%; p < .001); moreover, a significant decrease in the wet-to-dry ratio was achieved (p < .001). CONCLUSION: Postconditioning was able to reduce local complications after a long-lasting lower limb vascular occlusion.


Asunto(s)
Poscondicionamiento Isquémico/métodos , Músculo Esquelético/irrigación sanguínea , Daño por Reperfusión/prevención & control , Animales , Arteriopatías Oclusivas/enzimología , Arteriopatías Oclusivas/patología , Arteriopatías Oclusivas/prevención & control , Creatina Quinasa/sangre , Extremidades , Masculino , Músculo Esquelético/enzimología , Músculo Esquelético/lesiones , Ratas , Ratas Wistar , Daño por Reperfusión/enzimología , Daño por Reperfusión/patología , Factores de Tiempo
12.
PLoS One ; 9(1): e84783, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24454750

RESUMEN

Acute lower extremity ischemia is a limb- and life-threatening clinical problem. Rapid detection of the degree of injury is crucial, however at present there are no exact diagnostic tests available to achieve this purpose. Our goal was to examine a novel technique - which has the potential to accurately assess the degree of ischemic muscle injury within a short period of time - in a clinically relevant rodent model. Male Wistar rats were exposed to 4, 6, 8 and 9 hours of bilateral lower limb ischemia induced by the occlusion of the infrarenal aorta. Additional animals underwent 8 and 9 hours of ischemia followed by 2 hours of reperfusion to examine the effects of revascularization. Muscle samples were collected from the left anterior tibial muscle for viability assessment. The degree of muscle damage (muscle fiber viability) was assessed by morphometric evaluation of NADH-tetrazolium reductase reaction on frozen sections. Right hind limbs were perfusion-fixed with paraformaldehyde and glutaraldehyde for light and electron microscopic examinations. Muscle fiber viability decreased progressively over the time of ischemia, with significant differences found between the consecutive times. High correlation was detected between the length of ischemia and the values of muscle fiber viability. After reperfusion, viability showed significant reduction in the 8-hour-ischemia and 2-hour-reperfusion group compared to the 8-hour-ischemia-only group, and decreased further after 9 hours of ischemia and 2 hours of reperfusion. Light- and electron microscopic findings correlated strongly with the values of muscle fiber viability: lesser viability values represented higher degree of ultrastructural injury while similar viability results corresponded to similar morphological injury. Muscle fiber viability was capable of accurately determining the degree of muscle injury in our rat model. Our method might therefore be useful in clinical settings in the diagnostics of acute ischemic muscle injury.


Asunto(s)
Isquemia/patología , Fibras Musculares Esqueléticas/patología , Animales , Isquemia/fisiopatología , Masculino , Microcirculación , Fibras Musculares Esqueléticas/ultraestructura , NADH Tetrazolio Reductasa/metabolismo , Ratas , Ratas Wistar , Daño por Reperfusión/patología , Daño por Reperfusión/fisiopatología , Supervivencia Tisular
13.
J Surg Res ; 187(2): 427-37, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24238973

RESUMEN

BACKGROUND: Mesenteric ischemia is a serious clinical condition requiring immediate surgical intervention. The unavoidable ischemic-reperfusion (IR) injury may be ameliorated using the appropriate postconditioning protocol. The aim of the present study was to investigate the optimal postconditioning algorithm in a rat model of intestinal ischemic-reperfusion injury. MATERIALS AND METHODS: Male Wistar rats were randomized into five groups (n = 10), one sham-operated, one IR, and three postconditioned groups, each with different protocols. The animals were subjected to 60 min of mesenteric ischemia, followed by 60 min of reperfusion. Postconditioning was applied at the onset of reperfusion using three different algorithms. Arterial pressure and mucosal microcirculation were monitored throughout the experiment. Mesenteric pH was determined at the early phase of reperfusion. Blood and tissue samples were taken at the end of reperfusion for histologic evaluation, serum lactate dehydrogenase, serum creatine kinase, serum tumor necrosis factor-α, serum interleukin-6, detailed mucosal antioxidant, and scavenger capacity assays. RESULTS: The shorter and intermediate length cycles of postconditioning enhanced mucosal microcirculation and redox state and significantly delayed the normalization of mesenteric pH. Furthermore, milder histopathologic lesions and lower concentrations of serum necroenzymes and proinflammatory cytokines were detected compared with the IR group. The protective effect of postconditioning using longer cycles could only be seen in a tendentious manner. CONCLUSIONS: In a rat model of intestinal ischemia-reperfusion, the shorter and intermediate length cycles of postconditioning proved to be more effective than the use of longer cycles.


Asunto(s)
Intestino Delgado/irrigación sanguínea , Poscondicionamiento Isquémico/métodos , Daño por Reperfusión/cirugía , Daño por Reperfusión/terapia , Algoritmos , Animales , Creatina Quinasa/sangre , Modelos Animales de Enfermedad , Hemodinámica/fisiología , Mucosa Intestinal/irrigación sanguínea , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patología , Intestino Delgado/metabolismo , Intestino Delgado/patología , L-Lactato Deshidrogenasa/sangre , Masculino , Microcirculación/fisiología , Distribución Aleatoria , Ratas , Ratas Endogámicas WF , Daño por Reperfusión/metabolismo , Factores de Tiempo
14.
Surg Today ; 44(12): 2345-53, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24374367

RESUMEN

PURPOSE: Rats are the most commonly used animal model for studies of acute lower limb ischemia-reperfusion. The ischemia induced by arterial clamping may cause milder damage than the application of a tourniquet if the presence of a possible collateral system is considered. METHODS: Male Wistar rats were randomized into three groups: in group A, the muscle weight affected by ischemia was measured; in group B, the severity of muscle damage caused by the application of a tourniquet and by infrarenal aortic occlusion was examined. Blood and muscle samples were taken from group B to assess the serum necroenzyme, potassium and TNF-α levels, as well as the muscle fiber viability and for histological examinations. In group C, the identification of the lower limb collateral system was performed using corrosion casting. RESULTS: Tourniquet application affected the lower muscle mass and resulted in significantly more severe injury compared to infrarenal aortic occlusion. This difference was reflected in the serum necroenzyme, potassium and TNF-α levels. The histological examination and viability assay confirmed these findings. The corrosion casts showed several anastomoses capable of supplying the lower limb. CONCLUSION: Tourniquet application proved to be capable of inducing absolute lower limb ischemia, in contrast to infrarenal aortic ligation, where a rich collateral system is considered to help mitigate the injury.


Asunto(s)
Aorta , Circulación Colateral/fisiología , Isquemia/fisiopatología , Extremidad Inferior/irrigación sanguínea , Daño por Reperfusión/fisiopatología , Reperfusión , Animales , Arteriopatías Oclusivas/patología , Arteriopatías Oclusivas/fisiopatología , Modelos Animales de Enfermedad , Isquemia/patología , Riñón/irrigación sanguínea , Ligadura , Masculino , Ratas Wistar , Daño por Reperfusión/patología , Torniquetes
15.
PLoS One ; 8(9): e73758, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24040056

RESUMEN

INTRODUCTION: Temporary occlusion of the hepatoduodenal ligament leads to an ischemic-reperfusion (IR) injury in the liver. Levosimendan is a new positive inotropic drug, which induces preconditioning-like adaptive mechanisms due to opening of mitochondrial KATP channels. The aim of this study was to examine possible protective effects of levosimendan in a rat model of hepatic IR injury. MATERIAL AND METHODS: Levosimendan was administered to male Wistar rats 1 hour (early pretreatment) or 24 hours (late pretreatment) before induction of 60-minute segmental liver ischemia. Microcirculation of the liver was monitored by laser Doppler flowmeter. After 24 hours of reperfusion, liver and blood samples were taken for histology, immuno- and enzyme-histochemistry (TUNEL; PARP; NADH-TR) as well as for laboratory tests. Furthermore, liver antioxidant status was assessed and HSP72 expression was measured. RESULTS: In both groups pretreated with levosimendan, significantly better hepatic microcirculation was observed compared to respective IR control groups. Similarly, histological damage was also reduced after levosimendan administration. This observation was supported by significantly lower activities of serum ALT (p early = 0.02; p late = 0.005), AST (p early = 0.02; p late = 0.004) and less DNA damage by TUNEL test (p early = 0.05; p late = 0.034) and PAR positivity (p early = 0.02; p late = 0.04). Levosimendan pretreatment resulted in significant improvement of liver redox homeostasis. Further, significantly better mitochondrial function was detected in animals receiving late pretreatment. Finally, HSP72 expression was increased by IR injury, but it was not affected by levosimendan pretreatment. CONCLUSION: Levosimendan pretreatment can be hepatoprotective and it could be useful before extensive liver resection.


Asunto(s)
Cardiotónicos/farmacología , Hidrazonas/farmacología , Hígado/irrigación sanguínea , Piridazinas/farmacología , Daño por Reperfusión/prevención & control , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Western Blotting , Daño del ADN/efectos de los fármacos , Proteínas del Choque Térmico HSP72/metabolismo , Inmunohistoquímica , Hígado/metabolismo , Masculino , Microcirculación/efectos de los fármacos , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Oxidación-Reducción/efectos de los fármacos , Poli(ADP-Ribosa) Polimerasas/metabolismo , Ratas , Ratas Wistar , Daño por Reperfusión/sangre , Daño por Reperfusión/fisiopatología , Simendán , Factores de Tiempo , Resultado del Tratamiento
16.
Magy Seb ; 66(3): 146-54, 2013 Jun.
Artículo en Húngaro | MEDLINE | ID: mdl-23782601

RESUMEN

INTRODUCTION: Operation on the infrarenal aorta could cause ischemic-reperfusion (IR) injury in local tissues and remote organs (e.g. the lung). OBJECTIVES: Our aim was to reduce long-term lung damage, after lower limb IR with postconditioning. MATERIALS AND METHODS: Male Wistar rats underwent 180 minutes of bilateral lower limb ischemia. Animals were divided into three groups: Sham-operated, IR, Postconditioned (PostC) and further to two subgroups according to reperfusion time: 24 h and 72 h. Serum free radical and IL-6 levels, histological changes, Wet/Dry (W/D) ratio, tissue myeloperoxidase (MPO) activity and Hsp72 levels were investigated. RESULTS: Postconditioning can reduce histological changes in the lung. Free radical levels are significantly lower in PostC groups than in IR groups (42.9 ± 8.0 vs. 6.4 ± 3.4; 27.3 ± 4.4 vs. 8.3 ± 4.0 RLU%; p < 0.05). IL-6 level (238.4 ± 31.1 vs. 209.1 ± 18.8; 190.0 ± 8.8 vs. 187.0 ± 14.9 pg/ml) and Hsp72 expression did not show any significant difference. Compared to the IR group, lung MPO activity did not change in the PostC groups. W/D ratio in PostC groups is significantly lower at all measured time-points (68% vs. 65%; 72% vs. 68%; p < 0.05). CONCLUSION: Postconditioning may reduce long-term damages of the lung after lower limb ischemic-reperfusion injury.


Asunto(s)
Poscondicionamiento Isquémico , Extremidad Inferior/irrigación sanguínea , Lesión Pulmonar/prevención & control , Daño por Reperfusión/prevención & control , Animales , Biomarcadores/sangre , Radicales Libres/metabolismo , Proteínas del Choque Térmico HSP72/sangre , Interleucina-6/sangre , Lesión Pulmonar/etiología , Lesión Pulmonar/patología , Masculino , Ratas , Ratas Wistar , Factores de Tiempo
17.
J Surg Res ; 185(1): 469-76, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23751804

RESUMEN

BACKGROUND: Operations on the infrarenal aorta can cause ischemic-reperfusion (IR) injury in local tissues, which could result in remote organ (e.g., lung) damage. Treatment of such injuries remains an unresolved problem. OBJECTIVES: Our aim was to reduce remote lung damage after lower limb IR by means of postconditioning. MATERIALS AND METHODS: Male Wistar rats were divided into three groups: Sham-operated, IR, and Postconditioned (PostC). In the latter two groups rats underwent 180 min of exclusion of the infrarenal aorta. The reperfusion time was 4 h. Serum-free radical levels, tumor necrosis factor-α and interleukin-6 concentrations, histologic changes in the lung, wet/dry-ratio, myeloperoxidase activity, heat shock protein 72 level and blood gas changes were investigated. RESULTS: Postconditioning reduced histological damage in the lung (P < 0.05). Free radical levels and tumor necrosis factor-α concentrations were significantly lower in the PostC group than in the IR group (P < 0.05 and P < 0.01, respectively). Interleukin-6 concentrations did not significantly differ in the PostC group. Compared with the IR group, lung myeloperoxidase activity was lower in the PostC group. Decreased pulmonary heat shock protein 72 level was observed in the PostC group compared with the IR group and the wet/dry-ratio was also significantly lower in the PostC group (P < 0.05). A noticeably higher arterial pO2 level was manifest in the PostC group after 2 and 4 h of reperfusion (P < 0.05). CONCLUSIONS: Postconditioning reduced lung damage under experimental conditions, in the early period of reperfusion after lower limb IR injury.


Asunto(s)
Lesión Pulmonar Aguda/terapia , Poscondicionamiento Isquémico/métodos , Complicaciones Posoperatorias/terapia , Daño por Reperfusión/complicaciones , Procedimientos Quirúrgicos Vasculares/efectos adversos , Lesión Pulmonar Aguda/etiología , Lesión Pulmonar Aguda/metabolismo , Animales , Aorta Abdominal/cirugía , Modelos Animales de Enfermedad , Radicales Libres/metabolismo , Miembro Posterior/irrigación sanguínea , Miembro Posterior/cirugía , Interleucina-6/metabolismo , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/metabolismo , Ratas , Ratas Wistar , Daño por Reperfusión/metabolismo , Instrumentos Quirúrgicos , Factor de Necrosis Tumoral alfa/metabolismo
18.
Magy Seb ; 65(4): 222-9, 2012 Aug.
Artículo en Húngaro | MEDLINE | ID: mdl-22940392

RESUMEN

INTRODUCTION: The ischemia-reperfusion injury of the small intestine is a condition of high mortality, which occurs following superior mesenteric artery (SMA) embolization or circulatory redistribution. The aim of the study was to evaluate the local and systemic effects of postconditioning in a rat model of small intestine ischemia-reperfusion. METHODS: Male Wistar rats underwent 60 min ischemia by the clamping of the SMA, followed by 6 hrs of reperfusion. The animals (n = 30) were randomized into three groups: sham-operated, control-, and postconditioned. Postconditioning was performed at the very onset of reperfusion by 6 alternating cycles of 10-10 seconds reperfusion/reocclusion, for a total of 2 min. At the end of the reperfusion blood and tissue (small intestine, lungs, kidney, liver) samples were taken for histological examination. The antioxidant status of small intestine was measured from intestinal homogenates. RESULTS: Histologic results revealed increased damage in control-group lungs, kidney, liver and small intestine in comparison with the postconditioned group. The injury was supported by significantly higher wet/dry weight ratio (p = 0.026), and serum levels of creatinine (p = 0.013), ASAT (p = 0.038), LDH (p = 0.028) and CK (p = 0.038) in the control group. The postconditioned group showed lower serum IL-6 levels (420 pg/ml vs. 188 pg/ml), as well as significantly higher mucosal antioxidant concentration. CONCLUSIONS: Postconditioning was able to decrease not only local, but the systemic damage intensity also, after a small intestinal ischemic-reperfusion episode.


Asunto(s)
Intestino Delgado/patología , Intestino Delgado/fisiopatología , Poscondicionamiento Isquémico , Daño por Reperfusión/prevención & control , Daño por Reperfusión/fisiopatología , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , HDL-Colesterol/sangre , Creatinina/sangre , Ensayo de Inmunoadsorción Enzimática , Poscondicionamiento Isquémico/métodos , Queratinas/sangre , Riñón/patología , Riñón/fisiopatología , Hígado/patología , Hígado/fisiopatología , Pulmón/patología , Pulmón/fisiopatología , Masculino , Arteria Mesentérica Superior/fisiopatología , Tamaño de los Órganos , Distribución Aleatoria , Ratas , Ratas Wistar , Daño por Reperfusión/etiología , Daño por Reperfusión/patología
19.
Magy Seb ; 63(6): 374-9, 2010 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-21147671

RESUMEN

INTRODUCTION: Surgical treatment for acute limb ischemia is revascularization or - when the limb is in a critical stage - amputation. Correct staging of the disease is relatively difficult, therefore complication and mortality rates are extremely high. Our aim was to invesitigate acute critical ischemia in rats and to test postconditioning on this model. METHODS: Experiment I: male Wistar rats underwent 4, 6, 8 hours of bilateral lower limb ischemia without reperfusion. Experiment II: suspected critical ischemia was followed by 2 hours of reperfusion with or without postconditioning. Histological samples were collected for routine staining and nitroblue-tetrazolium (NBT) enzyme-histochemistry. In Experiment II the microcirculatory changes were measured by laser Doppler flowmetry and blood samples were collected for laboratory testing (kreatin-kinase, CK). RESULTS: Experiment I: After an eight-hour-obstruction, severe ischemic lesions were detectable, with rutine and NBT stainings, therefore 8 hours of ischemia was chosen for further testing. Experiment II: The CK levels showed significant (p < 0.05) drop, quantitative evaluation of enzyme-histochemisty resulted in significantly (p < 0.001) less viability depletion and microcirculation showed significant (p < 0.05) amelioration of the reperfusion parameters in the postconditioned group compared to the control. CONCLUSIONS: Eight hours of lower limb ischemia is a suitable model to investigate acute critical ischemia in rats. Postconditioning could be a feasible technique to reduce IR injury associated with acute lower limb ischemia.


Asunto(s)
Miembro Posterior/irrigación sanguínea , Isquemia/complicaciones , Poscondicionamiento Isquémico , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Daño por Reperfusión/patología , Enfermedad Aguda , Animales , Biomarcadores/sangre , Creatina Quinasa/sangre , Modelos Animales de Enfermedad , Isquemia/patología , Isquemia/fisiopatología , Masculino , Músculo Esquelético/irrigación sanguínea , Ratas , Ratas Wistar , Daño por Reperfusión/enzimología , Daño por Reperfusión/fisiopatología , Daño por Reperfusión/cirugía
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