Spark J I, Chetter I C, Kester R C, Guillou P J, Scott D J
Department of Vascular, St. James's University Hospital, Leeds, U.K.
Eur J Vasc Endovasc Surg. 1997 Apr;13(4):407-12. doi: 10.1016/s1078-5884(97)80085-8.
To determine the effect that revascularising chronic critically ischaemic legs has no neutrophil activation and adhesion.
Prospective clinical study.
University Hospital.
Twenty-five patients, 16 men and nine women undergoing femorodistal surgery.
Venous blood assays for neutrophils expression of CD11b, neutrophil adhesion, and the plasma concentration of the shed endothelial adhesion receptor, soluble intracellular adhesion molecule 1 (sICAM-1). Urinary microalbuminaemia was measured and expressed as an albumin/creatinine ratio (ACR), as a marker of vascular permeability and plasma neutrophil elastase as evidence of neutrophil activation. Venous blood was taken preoperatively, during surgery and for the first 7 days postoperatively.
Neutrophil CD11b expression fell following reperfusion of the limb (21.4 mcf to 9.7 mcf, p < 0.02 Mann Whitney U-test) as did neutrophil adhesion (preop. 75% adhesion, postop. 28% p < 0.01). However, the plasma elastase levels rose from 95 micrograms/l to 345 micrograms/l at 4 h and the ACR increased from 5.3 mg/ml to 304.2 mg/ml. The concentration of sICAM-1 fell following reperfusion (p < 0.04).
The change in CD11b, sICAM-1 and adhesion may represent a normal immunological response to ischaemia/reperfusion.
