title: Biochemical markers of acute limb ischemia, rhabdomyolysis, and impact on limb salvage.
abstract: Biochemical markers of ischemia reperfusion injury have been of interest to vascular surgeons and researchers for many years. Acute limb ischemia is the quintessential clinical scenario where these markers would seem relevant. The use of biomarkers to preoperatively or perioperatively predict which patients will not tolerate limb-salvage efforts or who will have poor functional outcomes after salvage is of immense interest. Creatinine phosphokinase, myoglobin, lactate, lactate dehydrogenase, potassium, bicarbonate, and neutrophil/leukocyte ratios are a few of the studied biomarkers available. Currently, the most well-studied aspect of ischemia reperfusion injury is rhabdomyolysis leading to acute kidney injury. The last 10 years have seen significant progression and improvement in the treatment of rhabdomyolysis, from minor supportive care to use of continuous renal replacement therapy. Identification of specific biomarkers with predictive outcome characteristics in the setting of ischemia reperfusion injury will help guide therapeutic development and potentially mitigate pathophysiologic changes in acute limb ischemia, including rhabdomyolysis. These may further lead to improvements in short- and long-term surgical outcomes and limb salvage, as well as a better understanding of the timing and selection of intervention.
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: J Devin B
authors.initials: JD
authors.lastname: Watson
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Gifford
authors.affiliation: Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Harvard Medical School, 15 Parkman Street, WACC #440, Boston, MA 02114-3117. Electronic address: wclouse@partners.org.
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood*; D006801:Humans; D007511:Ischemia / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D023821:Limb Salvage / Q000009:adverse effects; D035002:Lower Extremity / Q000098:blood supply*; D018579:Patient Selection; D011237:Predictive Value of Tests; D015427:Reperfusion Injury / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D012206:Rhabdomyolysis / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers