[Effect of postconditioning in major vascular operations on rats].
BACKGROUND
Postconditioning - using alternating brief cycles of reperfusion/reocclusion applied just at the very beginning of reperfusion - has recently been described as a potent therapeutic technique, attenuating ischaemia-reperfusion injury. In vascular surgery, certain elective interventions involve cross-clamping of major arteries, resulting in temporary ischaemia in large peripheral organs, which thus suffer ischaemia-reperfusion injury. Patients undergoing these operations may develop also serious systemic complications such as multiple distant organ dysfunctions, SIRS, detrimental redistribution of the circulation or even shock, a phenomenon called reperfusion-syndrome. We studied the effects of postconditioning on reperfusion-syndrome in a rodent experimental model.


METHODS
Anaesthetized male Wistar rats underwent 180 minutes of bilateral lower limb ischaemia and 4 hours of reperfusion using an infrarenal cross-clamping of the abdominal aorta. Control animals underwent no additional intervention. Postconditioning consisted of 6 cycles of 10-second aortic occlusion/10-second declamping starting at the beginning of reperfusion. Haemodynamic parameters were observed with invasive arterial manometer, microcirculation of the lower limb was detected with laser-Doppler-flowmeter. After 4 hours of reperfusion serum, urine, and histological samples were collected.


RESULTS
180-minute ischaemia resulted in significant haemodynamic changes after reperfusion. Postconditioning affected the character of the microcirculatory flow curves, the limb circulation stabilized with hyperaemia after reperfusion. Postconditioning caused a significant reduction in systemic inflammatory response (TNF-alpha, oxygen-derived free radicals). The laboratory and histological samples implied a significant decrease in remote organ (lung and renal) dysfunctions after postconditioning.


CONCLUSIONS
Postconditioning proves to be capable in conferring protection against different organ injuries caused by longer circulatory occlusions during elective major vascular surgeries.
Szijártó
Attila
A
semmelweis egyetem, altalános orvostudományi kar i. sz. sebészeti klinika 1082 budapest ulloi út 78. szijartoattila@gmail.com
Gyurkovics
Endre
E
Arányi
Péter
P
Onody
Péter
P
Stangl
Rita
R
Tátrai
Miklós
M
Lotz
Gábor
G
Mihály
Zoltán
Z
Hegedüs
Viktor
V
Blázovics
Anna
A
Kupcsulik
Péter
P
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D000818:Animals; D006614:Hindlimb / Q000098:blood supply; D007511:Ischemia / Q000150:complications* / Q000473:pathology; D019194:Ischemic Preconditioning / Q000379:methods; D007668:Kidney / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000473:pathology / Q000517:prevention & control*; D012206:Rhabdomyolysis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*