Treffalls Rebecca N, Jodlowski Grzegorz, Wilken Silvana, Stonko David P, Walker Patrick F, Morrison Jonathan J
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
Sci Rep. 2025 Sep 25;15(1):32802. doi: 10.1038/s41598-025-17820-6.
Acute limb ischemia necessitates prompt revascularization to preserve viability and minimize systemic ischemia-reperfusion injury. Delays in care increase morbidity and mortality, underscoring the need for nonsurgical temporizing methods. Lower Extremity Extracorporeal Distal Revascularization (LEEDR) is a percutaneous technique that delivers oxygenated blood from the contralateral femoral artery to the ischemic limb via a retrograde tibial cannula. This study aimed to evaluate LEEDR compared to prolonged untreated warm ischemia. Anesthetized Yorkshire swine (40-60 kg) underwent hindlimb ischemia via endovascular balloon occlusion of the left external iliac and middle sacral arteries and were randomized to control (n = 6; 9 h ischemia) or LEEDR (n = 6; 1-h ischemia plus 8 h extracorporeal support). Revascularization was achieved by balloon deflation, followed by 48 h of observation. The primary outcome was survival; secondary outcomes included gait function, compartment pressure, and biochemical markers of ischemia-reperfusion injury. Survival was significantly higher in the LEEDR group (83% vs. 0%; p = .001). LEEDR animals demonstrated improved gait function (5.8 ± 0.34 vs. 2.5 ± 0.7; p < .001), lower compartment pressures (9.9 ± 1.7 vs. 28.5 ± 4.2 mm Hg; p < .001), and reduced serum potassium (4.57 ± 0.22 vs. 5.14 ± 0.54 mmol/L; p < .001) and lactate concentrations (1.4 ± 0.55 vs. 2.5 ± 1.6 mmol/L; p < .001) during reperfusion and recovery. LEEDR effectively mitigated the consequences of 9 h of warm ischemia in a swine model, improving survival, preserving limb function, and preventing compartment syndrome. This percutaneous technique may serve as a viable temporizing strategy in patients with delayed access to definitive revascularization.
急性肢体缺血需要迅速进行血管再通，以维持肢体存活并将全身缺血再灌注损伤降至最低。治疗延迟会增加发病率和死亡率，这突出了对非手术临时处理方法的需求。下肢体外远端血管再通术（LEEDR）是一种经皮技术，可通过逆行胫动脉插管将含氧血液从对侧股动脉输送至缺血肢体。本研究旨在评估LEEDR与长时间未经治疗的热缺血相比的效果。将麻醉后的约克夏猪（40 - 60千克）通过血管内球囊闭塞左髂外动脉和骶中动脉造成后肢缺血，然后随机分为对照组（n = 6；9小时缺血）或LEEDR组（n = 6；1小时缺血加8小时体外支持）。通过球囊放气实现血管再通，随后进行48小时观察。主要结局指标为生存率；次要结局指标包括步态功能、筋膜间隔压力以及缺血再灌注损伤的生化标志物。LEEDR组的生存率显著更高（83% 对0%；p = 0.001）。接受LEEDR治疗的动物在再灌注和恢复过程中步态功能改善（5.8 ± 0.34对2.5 ± 0.7；p < 0.001）、筋膜间隔压力更低（9.9 ± 1.7对28.5 ± 4.2毫米汞柱；p < 0.001），血清钾（4.57 ± 0.22对5.14 ± 0.54毫摩尔/升；p < 0.001）和乳酸浓度降低（1.4 ± 0.55对2.5 ± 1.6毫摩尔/升；p < 0.001）。LEEDR有效减轻了猪模型中9小时热缺血的后果，提高了生存率，保留了肢体功能，并预防了筋膜间隔综合征。这种经皮技术可能成为延迟进行确定性血管再通治疗的患者可行的临时策略。
