INFLUENCING FACTOR ANALYSIS OF NO-REFLOW PHENOMENON AFTER REPERFUSION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA ASSOCIATED WITH ACUTE THROMBOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAO Yujun , REN Wei

Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

Keywords：

Arteriosclerosis obliterans; Ischemic reperfusion injury; No-reflow phenomenon; Acute thrombosis; Influencing factor

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【Abstract】 Objective To analyze the influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis. Methods Between January 2009 and December 2010, 59 patients (67 limbs) with chronic limb ischemia associated with acute thrombosis were treated. According to whether the no-reflow phenomenon occurred or not, the patients were divided into no-reflow group (19 patients, 21 limbs) and reflow group (40 patients, 46 limbs). Logistic regression was used to analyze the roles of ischemia time, ischemia extent, smoking, hypertension, cardiovascular and cerebrovascular disease, diabetes, surgical procedure, platelet count, fibrinogen (FBG), prostaglandin I2 (PGI2), and thromboxane A2 (TXA2) on no-reflow phenomenon after reperfusion. Results The results of the logistic regression analysis indicated that ischemia time (OR=7.196; 95%CI: 1.679-27.960), ischemia extent (OR=5.116; 95%CI: 1.399-109.338), smoking (OR=6.893; 95%CI: 3.704-2 291.003), diabetes (OR=3.864; 95%CI: 1.009-421.702), PGI2 (OR=7.985; 95%CI: 1.001-1.043), and TXA2 (OR=7.643; 95%CI: 1.011-1.065) were the high risk factors of no-reflow phenomenon. The levels of TXA2 and FBG in no-reflow group were significantly increased and the level of PGI2 was decreased, showing significant differences when compared with the reflow group (P lt; 0.05). However, no significant difference was found in the platelet count between 2 groups (P gt; 0.05). Conclusion Ischemia extent and ischemia time are the main influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis, and the patients combined with smoking or diabetes are high risk population of the no-reflow phenomenon. Postoperative patients with no-reflow phenomenon are at a hypercoagulable state in vivo, in which prostacyclin plays an important role.

Citation： HAO Yujun,REN Wei. INFLUENCING FACTOR ANALYSIS OF NO-REFLOW PHENOMENON AFTER REPERFUSION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA ASSOCIATED WITH ACUTE THROMBOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(3): 336-340. doi: Copy

1.	Burt RK, Testori A, Oyama Y, et al. Autologous peripheral blood CD133+ cell implantation for limb salvage in patients with critical limb ischemia. Bone Marrow Transplant, 2010, 45(1): 111-116.
2.	Lawall H, Bramlage P, Amann B. Treatment of peripheral arterial disease using stem and progenitor cell therapy. J Vasc Surg, 2011, 53(2): 445-453.
3.	Amann B, Luedemann C, Ratei R, et al. Autologous bone marrow cell transplantation increases leg perfusion and reduces amputations in patients with advanced critical limb ischemia due to peripheral artery disease. Cell Transplant, 2009, 18(3): 371-380.
4.	Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation, 2002, 105(5): 656-662.
5.	Henke PK. Contemporary management of acute limb ischemia: factors associated with amputation and in-hospital mortality. Semin Vasc Surg, 2009, 22(1): 34-40.
6.	Eliason JL, Wainess RM, Proctor MC, et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg, 2003, 238(3): 382-389.
7.	Lepper W, Hoffmann R, Kamp O, et al. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angiography in patients with acute myocardial infarction. Circulation, 2000, 101(20): 2368-2374.
8.	Gibson CM, Canon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation, 2000, 101(2): 125-130.
9.	Wang WZ, Fang XH, Stephenson LL, et al. Ischemia-reperfusion-induced apoptotic endothelial cells isolated from rat skeletal muscle. Plast Reconstr Surg, 2009, 123(2): 131S-138S.
10.	Wang MX, Liu YY, Hu BH, et al. Total salvianolic acid improves ischemia-reperfusion-induced microcirculatory disturbance in rat mesentery. World J Gastroenterol, 2010, 16(42): 5306-5316.
11.	Bekkers SC, Yazdani SK, Virmani R, et al. Microvascular obstruction: underlying pathophysiology and clinical diagnosis. J Am Coll Cardiol, 2010, 55(16): 1649-1660.
12.	Wissler RW, Vesselinovitch D, Getz GS. Abnormalities of the arterial wall and its metabolism in atherogenesis. Prog Cardiovasc Dis, 1976, 18(5): 341-369.
13.	Shanahan CM, Cary NR, Salisbury JR, et al. Medical localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis: evidence for smooth muscle cell-mediated vascular calcification. Circulation, 1999, 100(21): 2168-2176.
14.	Airoldi F, Faglia E, Losa S. Antegrade approach for percutaneous interventions of ostial superficial femoral artery: outcomes from a prospective series of diabetic patients presenting with critical limb ischemia. Cardiovasc Revasc Med, 2011. [Epub ahead of print].
15.	Dawson I, van Bockel JH. Reintervention and mortality after infrainguinal reconstructive surgery for leg ischemia. Br J Surg, 1999, 86(1): 38-44.
16.	Bonderman D, Teml A, Jakowitsch J, et al. Coronary no-reflow is caused by shedding of active tissue factor from dissected atherosclerotic plaque. Blood, 2002, 99(8): 2794-2800.
17.	Schwierz T, Gschwendtner M, Havlicek W, et al. Indications for directed thrombolysis or new bypass in treatment of occlusion of lower extremity arterial bypass reconstruction. Ann Vasc Surg, 2001, 15(6): 644-652.
18.	Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg, 2009, 22(1): 5-9.

1. Burt RK, Testori A, Oyama Y, et al. Autologous peripheral blood CD133+ cell implantation for limb salvage in patients with critical limb ischemia. Bone Marrow Transplant, 2010, 45(1): 111-116.
2. Lawall H, Bramlage P, Amann B. Treatment of peripheral arterial disease using stem and progenitor cell therapy. J Vasc Surg, 2011, 53(2): 445-453.
3. Amann B, Luedemann C, Ratei R, et al. Autologous bone marrow cell transplantation increases leg perfusion and reduces amputations in patients with advanced critical limb ischemia due to peripheral artery disease. Cell Transplant, 2009, 18(3): 371-380.
4. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation, 2002, 105(5): 656-662.
5. Henke PK. Contemporary management of acute limb ischemia: factors associated with amputation and in-hospital mortality. Semin Vasc Surg, 2009, 22(1): 34-40.
6. Eliason JL, Wainess RM, Proctor MC, et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg, 2003, 238(3): 382-389.
7. Lepper W, Hoffmann R, Kamp O, et al. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angiography in patients with acute myocardial infarction. Circulation, 2000, 101(20): 2368-2374.
8. Gibson CM, Canon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation, 2000, 101(2): 125-130.
9. Wang WZ, Fang XH, Stephenson LL, et al. Ischemia-reperfusion-induced apoptotic endothelial cells isolated from rat skeletal muscle. Plast Reconstr Surg, 2009, 123(2): 131S-138S.
10. Wang MX, Liu YY, Hu BH, et al. Total salvianolic acid improves ischemia-reperfusion-induced microcirculatory disturbance in rat mesentery. World J Gastroenterol, 2010, 16(42): 5306-5316.
11. Bekkers SC, Yazdani SK, Virmani R, et al. Microvascular obstruction: underlying pathophysiology and clinical diagnosis. J Am Coll Cardiol, 2010, 55(16): 1649-1660.
12. Wissler RW, Vesselinovitch D, Getz GS. Abnormalities of the arterial wall and its metabolism in atherogenesis. Prog Cardiovasc Dis, 1976, 18(5): 341-369.
13. Shanahan CM, Cary NR, Salisbury JR, et al. Medical localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis: evidence for smooth muscle cell-mediated vascular calcification. Circulation, 1999, 100(21): 2168-2176.
14. Airoldi F, Faglia E, Losa S. Antegrade approach for percutaneous interventions of ostial superficial femoral artery: outcomes from a prospective series of diabetic patients presenting with critical limb ischemia. Cardiovasc Revasc Med, 2011. [Epub ahead of print].
15. Dawson I, van Bockel JH. Reintervention and mortality after infrainguinal reconstructive surgery for leg ischemia. Br J Surg, 1999, 86(1): 38-44.
16. Bonderman D, Teml A, Jakowitsch J, et al. Coronary no-reflow is caused by shedding of active tissue factor from dissected atherosclerotic plaque. Blood, 2002, 99(8): 2794-2800.
17. Schwierz T, Gschwendtner M, Havlicek W, et al. Indications for directed thrombolysis or new bypass in treatment of occlusion of lower extremity arterial bypass reconstruction. Ann Vasc Surg, 2001, 15(6): 644-652.
18. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg, 2009, 22(1): 5-9.

Chinese Journal of Reparative and Reconstructive Surgery

INFLUENCING FACTOR ANALYSIS OF NO-REFLOW PHENOMENON AFTER REPERFUSION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA ASSOCIATED WITH ACUTE THROMBOSIS

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