Effect of prostaglandin E1 on ischemia-reperfusion injury during abdominal aortic aneurysm surgery.
OBJECTIVE
Abdominal aortic aneurysm (AAA) surgery subjects the lower extremities to ischemia and reperfusion. Although it is not extensive or prolonged, ischemia of the lower extremities during aortic cross-clamping is gradually and steadily induced. We studied the effects of prostaglandin E1 (PGE1) on ischemia-reperfusion injury of the lower extremities during AAA repair.


METHODS
During AAA surgery, two near-infrared spectroscopy probes were positioned on each calf muscle to monitor oxygen metabolism in the lower extremities. We also measured lactate concentration in both iliac veins.


RESULTS
Near-infrared spectroscopy signals responded sensitively to aortic cross-clamping and declamping. Lactate increased time-dependently during aortic cross-clamping. The continuous venous administration of PGE1 (20 ng/kg per minute) inhibited the accumulation of lactate during aortic cross-clamping. Declamping of the first iliac artery resulted in a further but transient increase in ipsilateral venous lactate, which may be one component in the mechanism of declamping shock. Prostaglandin E1 eliminated the transient increase in ipsilateral lactate. The administration of PGE1 inhibited the contralateral accumulation of lactate after first declamping, and the lactate level decreased gradually before the second declamping.


CONCLUSIONS
Prostaglandin E1 seems to have a protective effect against ischemia-reperfusion injury of the lower extremities during AAA surgery.
Sako
Hidenori
H
Department of Cardiovascular Surgery, Oita University, School of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
Hadama
Tetsuo
T
Miyamoto
Shinji
S
Anai
Hirofumi
H
Wada
Tomoyuki
T
Iwata
Eriko
E
Hamamoto
Hirotsugu
H
Tanaka
Hideyuki
H
Urushino
Keiko
K
Shuto
Takashi
T
D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000188:drug therapy*; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D012016:Reference Values; D012086:Reoperation; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
D000527:Alprostadil