De l'etude des alterations biochimiques du muscle squelettique ischémie et reperfuse à la reperfusion contrôlée des membres chez des patients en ischemie aigue severe

The reperfusion of a limb which has been submitted to a severe and prolonged period of ischemia may be followed by dramatic local and systemic complications. The results of several experimental studies have given insights on the biochemical and physiopathological alterations occurring in the ischemic and reperfused skeletal muscle. Therefore the technique of the controlled limb reperfusion has been developed. we present the results obtained in two patients with this technique. Two patients were admitted for a limb-threatening ischemia consecutive to embolism. After removal of the thrombi with a Fogarty's catheter and before reperfusion with the normal blood, a controlled limb reperfusion was performed by mixing the systemic blood with a crystalloid solution in order to obtain a hyperosmolar, hypocalcemic, alcalotic and substrate-enriched (aspartate and glutamate) reperfusate. This reperfusate was infused during 30 min with a roller pump into the deep and superficial femoral arteries. The delivery conditions (temperature, flow and reinjection pressure) were closely monitored. In both cases, no post-operative complication was observed and the pedal pulses were restored after the operation. Complete recovery of the motor and sensitive functions were observed and the patient were discharged at the 10th post-operative day.