Year 2015 Vol. 23 No 3

CASE REPORTS

R.E. KALININ, A.S. PSHENNIKOV, I.A. SUCHKOV

REPERFUSION INJURY OF TISSUES IN LOWER LIMB ARTERIAL RECONSTRUCTIVE SURGERY

SBEE HPE "Ryazan State Medical University named after I.P. Pavlov",
The Russian Federation

This work represents the analysis of clinical cases of treatment patients suffering from obliterating arterial atherosclerosis of the lower limbs.
In all cases in the early postoperative period providing an adequate main blood flow restoring an acute disease progressing took place that required limb amputation.
The initial levels of nitric oxide metabolites (NO), vascular endothelial growth factors (VEGF), pro-apoptotic proteins (Bcl-2), heat shock proteins (HSP70) were determined in patients by standard methods (biological material blood, ELISA analyzers EKS 715 Hsp70, BMS244 Bcl 2, KHG 0111 VEGF; Griess reagent) prior and after surgery.
The reduction of the studied parameters (NO, VEGF, and HSP70) reflects the severity and depth of the endothelial vascular and tissue lesion of the limb within the reperfusion injury in the postoperative period. The above-mentioned phenomena manifest the inhibition of the microcirculatory bed function.
In the postoperative period the elevation of Bcl-2 protein level should be regarded as a mechanism of the positive feedback in the regulation of apoptotic process in the limb affected by severe necrotic changes.
Conclusion. The clinical cases show an obvious reduction of the endothelial reserves and as a consequence an inhibition of vascular endothelial function in patients with peripheral arterial occlusive disease Pokrovsky-Fontaine stage IV.
The outcome of the successful reconstructive procedure on the main vessels is mainly caused by tissue tolerance to reperfusion injury while a profound biochemical analysis of stress-limiting system may reveal a predictive model of the initial post-operative course of the disease from the post-ischemic injury point of view.

Keywords: reperfusion, post ischemic syndrome, classification of Pokrovsky- Fontaine, reconstructive surgery of the main arteries, tissue tolerance, necrotic changes, a predictive model
p. 348-352 of the original issue
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Address for correspondence:
390028, Rossiyskaya Federatsiya,
g. Ryazan, ul. Vyisokovoltnaya 9,
GBOU VPO "Ryazanskiy gosudarstvennyiy meditsinskiy universitet
imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel.: 7-910-900-95-23,
e-mail: Pshennikov1610@rambler.ru,
Pshennikov Aleksandr Sergeevich
Information about the authors:
Kalinin P.E. MD, professor, a head of the chair of angiology, vascular, operative surgery and topographical anatomy, Rector of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
Pshennikov A.S. PhD, an assistant of the chair of angiology, vascular, operative surgery and topographical anatomy of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
Suchkov I.A. MD, an associate professor of the chair of angiology, vascular, operative surgery and topographical anatomy of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
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