Busato Cesar Roberto, Utrabo Carlos Alberto Lima, Lipinski Leandro Cavalcante, de Lima Keizi Dayane, Guilherme Márcio Dias, Medeiros Nicolas Brandalize, Fagundes Samela Basi, Josviak Willman
Universidade Estadual de Ponta Grossa - UEPG, Departamento de Medicina, Ponta Grossa, PR, Brasil.
J Vasc Bras. 2017 Jul-Sep;16(3):187-194. doi: 10.1590/1677-5449.009016.
There are few options for treating critical ischemia in limbs with no distal patency. Diverting flow through the venous circulation is an option supported by evidence from numerous published studies.
To compare the behavior of clinical and laboratory variables between the hind limbs of pigs subjected to ischemia and to ischemia with reperfusion by retrograde circulation and between these intervention groups and a control group.
Ten pigs were divided into 2 groups. In group 1 (n=5), controls, patterns of physiological variables such as flow according to Doppler ultrasound, temperature, blood gas analysis results, lactate, creatine kinase, and blood pressure were evaluated. In group 2 (n=5), after an initial ischemia period with mean duration of 27 minutes and 30 seconds, provoked by interrupting flow through the femoral arteries, the animals were subjected to venous arterialization of the left hind limb while the right hind limb was maintained in ischemia. Variables were analyzed separately for each hind leg at 0, 2, 3, 4, and 6 hours after reperfusion and compared against each other and the control group.
Analysis of variables from both procedures showed decreases in BE and PO and significant increases in lactate and creatine kinase, in relation to the control group. In arterialized ischemic limbs, we observed flow on Doppler ultrasound, and arterial pressures and temperatures were higher than in the ischemic limbs.
Comparative analysis of the extremities in ischemia and arterialized ischemia showed, in relation to the control group, metabolic acidosis with significant increases in lactate and creatine kinase, suggesting cellular damage, and there were signs of retrograde reperfusion in arterialized extremities.
对于肢体远端无通畅血管的严重缺血情况，治疗选择有限。通过静脉循环分流血流是众多已发表研究证据支持的一种选择。
比较接受缺血、逆行循环缺血再灌注的猪后肢与这些干预组和对照组之间临床和实验室变量的变化情况。
将10头猪分为2组。第1组（n = 5）为对照组，评估诸如根据多普勒超声测得的血流、温度、血气分析结果、乳酸、肌酸激酶和血压等生理变量模式。第2组（n = 5），在通过中断股动脉血流引发平均持续时间为27分30秒的初始缺血期后，对动物的左后肢进行静脉动脉化，而右后肢保持缺血状态。在再灌注后0、2、3、4和6小时分别对每只后肢的变量进行分析，并相互比较以及与对照组比较。
两种手术的变量分析显示，与对照组相比，碱剩余（BE）和氧分压（PO）降低，乳酸和肌酸激酶显著升高。在动脉化的缺血肢体中，我们通过多普勒超声观察到血流，且动脉压和温度高于缺血肢体。
与对照组相比，对缺血和动脉化缺血肢体的比较分析显示存在代谢性酸中毒，乳酸和肌酸激酶显著升高，提示细胞损伤，并且动脉化肢体有逆行再灌注的迹象。
