New hope for an old cure: a pilot animal study on selective venesection in attenuating the systemic effects of ischaemic-reperfusion injury.
BACKGROUND
Reperfusion of acutely ischaemic tissue may, paradoxically, lead to systemic complications. This phenomenon is believed to be initiated by humoral factors that have accumulated in the ischaemic tissue. The ancient art of venesection may reduce the load of these mediators at the point of reperfusion. The aim of this study is to test if selective venesection, by removing the initial venous return from the ischaemic tissue, can attenuate the systemic effects of the ischaemic-reperfusion injury using a porcine model of acute limb ischaemia.


METHODS
The right femoral arteries of anaesthetised female pigs were clamped. Twelve pigs were divided into 2 groups (n = 6 per group). In the treatment group, 5% of blood volume was venesected from the ipsilateral femoral vein upon reperfusion; the other arm served as control. The animals were sacrifi ced after 4 days for histological examination. A pathologist, blinded to the experimental groups, graded the degree of microscopic injury.


RESULTS
For the control group, the kidneys showed glomeruli and tubular damage. The livers demonstrated architectural distortion with cellular oedema. There was pulmonary oedema as well as extensive capillary congestion and neutrophil infiltration. Such findings were absent or reduced in the venesected animals. Consequently, the injury scores for the kidney, lung, liver and heart were significantly less for the venesected animals.


CONCLUSIONS
Selective venesection reduces the remote organ injuries of the ischaemic-reperfusion phenomenon.
Ho
Choon-Kiat
CK
Department of General Surgery, Tan Tock Seng Hospital, Singapore. choon_kiat_ho@ttsh.com.sg
Lee
Chee-Wei
CW
Lu
Jia
J
Wu
Jian
J
Koh
Woon-Puay
WP
Chan
Chung-Yip
CY
Homer-Vanniasinkam
Shervanthi
S
Chao
Alexandre K H
AK
D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006614:Hindlimb / Q000293:injuries*; D009102:Multiple Organ Failure / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D018962:Phlebotomy; D011654:Pulmonary Edema / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D015427:Reperfusion Injury / Q000150:complications* / Q000628:therapy*; D034421:Sus scrofa