Controlled limb reperfusion with a simplified perfusion system.

Abstract

UNLABELLED: The goal of revascularisation of an acutely ischemic limb is to prevent the loss of the extremity and to enable return of normal function. Although reperfusion of an ischemic limb is a prerequisite for the preservation or reestablishment of function, it may, in itself, cause further injury. Controlled reperfusion after revascularisation may reduce this injury and may facilitate return of normal function. Thus far, the technique of controlled limb reperfusion required the use of cardiosurgical equipment and has therefore been reserved for cardiac surgery centers. However, the majority of patients with acute limb ischemia are referred to hospitals, where the technical equipment for controlled reperfusion is not available. We modified the technique of controlled limb reperfusion using a simplified perfusion system with a pressure-cuffed bag, which allows controlled reperfusion without the use of a roller pump. The modified reperfusion technique was applied to 9 patients with acute and persistent ischemia of the limbs (mean ischemic period: 21 +/- 21 hours). Controlled reperfusion consisted of a 30 min infusion of a normothermic reperfusate solution, which was mixed with the patient's blood (6:1, blood/reperfusate ratio) distally to the proximal obstruction. RESULTS: Five patients (56%) recovered with normal function of the limb. Two patients (22%) lost the ischemic limb (ischemic periods: 77 h and 9h; creatine kinase before operation: 6230 U/I and 1045 U/I): another two patients (22%) died, who were in profound cardiogenic shock. CONCLUSION: The simplified perfusion system allows to put controlled limb reperfusion into practice in any operating room. The results support the notion that controlled limb reperfusion should be applied in any patient with acute ischemia of an extremity.