Effect of vitamin E on reperfusion injuries during reconstructive vascular operations on lower limbs.
BACKGROUND
The challenge against reperfusion injury and tissue oxidative stress, especially in vascular surgical interventions has an essential importance to reach the optimal clinical result. Numerous experimental attempts have proved the positive antioxidant effect of vitamin E in both chronic and acute phase models. In our study we monitored the effect of continuous preoperative treatment with vitamin E, on oxidative stress and tissue inflammation reactions developed after reconstructive operations.


METHODS
32 patients have been involved in a randomized, prospective study, all suffering from AFS occlusion proved by angiography, and all undergone supragenual reconstruction. Duration of ischemia and amount of tissues under vascular clamping were almost the same in all patients. In the group treated with E-vitamin, we administered 1 x 200 mg of vitamin E p/o from the preoperative day till the 7th post operative day. Patients of the second group did not receive vitamin E.


METHODS
Peripheral blood samples were collected immediately before operation and at the end of the second reperfusion hour (early reperfusion period). Late reperfusion period has been monitored by analyzing blood samples taken at 24th hour and 7th day next to the operative ischemia. Among oxidative stress parameters, direct measurement of reactive oxygen intermediator (ROI) and determination of antioxidant state (GSH, Total-SH group, SOD) have been performed. Malondialdehyde was chosen as marker for lipidperoxidation. Inflammation reactions were monitored up on expression of adhesion molecules (CD11a and CD18). We also controlled the oscillation of myeloperoxidase (MPO) activity.


RESULTS
Our study has proved that preoperative (from the preoperative day till the 7th post operative day) administration of 200 mg vitamin E could reduce the level of oxidative stress developed after ischemic-reperfusion insult (lipidproxidation, antioxidant enzymes). According to our results, the prooxidant-antioxidant imbalance also diminished in the group with E-vitamin treatment. We proved that elective administration of vitamin E could decrease the WBC activity (MPO activity, free radicals production, expression of adhesion molecules) and its consequential local inflammation process, during early reperfusion.
Arató
E
E
Department of General and Vascular Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary. aratoendre@gmail.com
Kürthy
M
M
Sínay
L
L
Kasza
G
G
Menyhei
G
G
Hardi
P
P
Masoud
S
S
Ripp
K
K
Szilágyi
K
K
Takács
I
I
Miklós
Z
Z
Bátor
A
A
Lantos
J
J
Kollár
L
L
Roth
E
E
Jancsó
G
G
D000975:Antioxidants / Q000008:administration & dosage; D003251:Constriction, Pathologic / Q000601:surgery; D005978:Glutathione / Q000097:blood; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007962:Leukocytes / Q000378:metabolism; D015227:Lipid Peroxidation / Q000187:drug effects; D035002:Lower Extremity / Q000098:blood supply*; D008315:Malondialdehyde / Q000097:blood; D018384:Oxidative Stress / Q000187:drug effects*; D011300:Preoperative Care; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000097:blood / Q000188:drug therapy*; D013482:Superoxide Dismutase / Q000097:blood; D014656:Vascular Surgical Procedures / Q000379:methods; D014810:Vitamin E / Q000008:administration & dosage*
D000975:Antioxidants; D014810:Vitamin E; D008315:Malondialdehyde; D013482:Superoxide Dismutase; D005978:Glutathione