Djoric P, Zeleskov-Djoric J, Stanisavljevic D M, Markovic Z D, Zivkovic V, Vuletic M, Djuric D, Jakovljevic V
Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
Eur Surg Res. 2012;48(4):200-7. doi: 10.1159/000338619. Epub 2012 Jun 7.
In patients with unreconstructable arterial occlusive disease distal venous arterialization (DVA) seems to be a promising option in the treatment. The goals of this prospective study were to assess clinical efficiency and possible impact of DVA on tissue damage by estimating oxidative status of patients with critical limb ischemia treated with this procedure. The subjects were 60 randomized patients: 30 were undergoing DVA and 30 were treated with antiaggregation therapy. During the mean follow-up period (6.13 ± 4.32 months for DVA vs. 6.74 ± 0.5 months for antiaggregation therapy) survival (p < 0.01), limb salvage (p < 0.001), pain relief (p < 0.001) and wound healing (p < 0.001) rates were significantly different between the two groups of patients in favor of the DVA group. Ten minutes after declamping we observed a decreasing trend in the lactate level in the blood of the deep venous system (p < 0.001). Also, on postoperative day 7 digital systolic pressure and digital-brachial index were higher than before the operation (p < 0.001). In blood samples collected immediately before and successively at 1, 3, 5 and 10 min postoperatively, prooxidative status (thiobarbituric acid reactive substances, O(2)(-), H(2)O(2) and nitric oxide) and antioxidative enzymes (superoxide dismutase, catalase and glutathione reductase) were determined spectrophotometrically. Using the nonparametric Friedman test, we noted statistically nonsignificant differences (p > 0.05) in values of both prooxidative parameters and enzymes of the antioxidative defense system, before and successively at 1, 3, 5 and 10 min after operation. These results indicate that there was no statistically significant reperfusion injury after revascularization, which could have been expected after this surgical procedure, thus confirming its validity in these patients.
在患有无法重建的动脉闭塞性疾病的患者中，远端静脉动脉化（DVA）似乎是一种有前景的治疗选择。这项前瞻性研究的目的是通过评估接受该手术治疗的严重肢体缺血患者的氧化状态，来评估DVA的临床疗效及其对组织损伤的可能影响。研究对象为60例随机分组的患者：30例行DVA手术，30例接受抗聚集治疗。在平均随访期内（DVA组为6.13±4.32个月，抗聚集治疗组为6.74±0.5个月），两组患者的生存率（p<0.01）、肢体挽救率（p<0.001）、疼痛缓解率（p<0.001）和伤口愈合率（p<0.001）有显著差异，DVA组更具优势。松开血管夹10分钟后，我们观察到深静脉系统血液中乳酸水平呈下降趋势（p<0.001）。此外，术后第7天手指收缩压和指肱指数高于术前（p<0.001）。在术前即刻以及术后1、3、5和10分钟依次采集的血样中，用分光光度法测定促氧化状态（硫代巴比妥酸反应性物质、O₂⁻、H₂O₂和一氧化氮）和抗氧化酶（超氧化物歧化酶、过氧化氢酶和谷胱甘肽还原酶）。使用非参数Friedman检验，我们发现术前以及术后1、3、5和10分钟时促氧化参数和抗氧化防御系统酶的值在统计学上无显著差异（p>0.05）。这些结果表明，血管重建术后没有统计学上显著的再灌注损伤，而这在该手术过程后是可能预期的，从而证实了该手术在这些患者中的有效性。
