Protection of the spinal cord from ischemia: comparative effects of levosimendan and iloprost.

BACKGROUND: The purpose of the study was to investigate and compare iloprost and levosimendan on spinal cord ischemia in an experimental model. MATERIALS AND METHODS: The study was done in two stages. For the 4-hour short survival study, 50 New Zealand white rabbits were randomly allocated into five groups. Spinal cord ischemia was induced by clamping the aorta just below the left renal artery and just proximal to the aortic bifurcation with bulldog artery clamps. The aortic clamps were removed after 40 min and restoration of blood flow was verified visually. The groups were analyzed at 1 and 4 h after reperfusion. For the 48-hour survival study, two different groups (iloprost plus levosimendan, n = 10; saline-treated controls, n = 10) were analyzed at 24 and 48 h after reperfusion. RESULTS: The neurologic status of the animals in the treatment and sham groups was better than that in the control group both at 1 and 4 h after reperfusion. Viability index values in the levosimendan, iloprost and iloprost plus levosimendan groups were statistically higher than in the control group indicating less or no neuronal damage. DISCUSSION: The results suggest that levosimendan, as well as iloprost, may reduce ischemic damage in transient spinal ischemia and provide better neurologic outcome.

A novel approach: ascending venous arterialization for atherosclerosis obliterans.

OBJECTIVE: Lower limb arterial occlusion with no patent distal artery suitable for revascularisation is a common problem. The aim of this study was to assess the role of revascularisation to distal veins (ascending venous arterialization) in patients not reconstructable by conventional bypass. METHOD: Ascending venous arterialization is a distal arteriovenous fistula. Reversed great saphenous vein grafts, from above the knee, were anastomosed to the common femoral artery, superficial femoral artery or popliteal artery and distally to the saphenous vein at the level of medial malleolus. No intervention was done to destroy the venous valves. The great saphenous vein was ligated below the knee. In this way, oxygenated blood could reach to dorsal venous arch and the tissues below the knee in an ascending fashion through the great saphenous vein, which was not removed. RESULTS: All of the patients recovered immediately after the operation. The lesions on the feet and on the toes of the patients improved in a short time. Intermittent claudication of the patients disappeared. Strong pulses were detected on the dorsal venous arch with manual Doppler in 3 weeks. The below knee tissues were perfused with the applied technique. CONCLUSION: Ascending venous arterialization can be applied for limb salvage to the patients who do not have a suitable arterial bed to revascularize with conventional techniques.