Ho, CK and Lee, CW and Lu, J and Wu, J and Koh, WP and Chan, CY and Homer-Vanniasinkam, S and Chao, AKH (2009) New Hope for an Old Cure: A Pilot Animal Study on Selective Venesection in Attenuating the Systemic Effects of Ischaemic-Reperfusion Injury. ANN ACAD MED SINGAP , 38 (7) 569 - 575.
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Introduction: Reperfusion of acutely ischaemic tissue may, paradoxically, lead to systemic complications. This phenomenon is believed to be initiated by humoral factors that have accumulated in the ischaemic tissue. The ancient art of venesection may reduce the load of these mediators at the point of reperfusion. The aim of this study is to test if selective venesection, by removing the initial venous return from the ischaemic tissue, can attenuate the systemic effects of the ischaemic-reperfusion injury using a porcine model of acute limb ischaemia. Materials and Methods: The right femoral arteries of anaesthetised female pigs were clamped. Twelve pigs were divided into 2 groups (n = 6 per group). In the treatment group, 5% of blood volume was venesected from the ipsilateral femoral vein upon reperfusion; the other arm served as control. The animals were sacrificed after 4 days for histological examination. A pathologist, blinded to the experimental groups, graded the degree of microscopic injury. Results: For the control group, the kidneys showed glomeruli and tubular damage. The livers demonstrated architectural distortion with cellular oedema. There was pulmonary oedema as well as extensive capillary congestion and neutrophil infiltration. Such findings were absent or reduced in the venesected animals. Consequently, the injury scores for the kidney, lung, liver and heart were significantly less for the venesected animals. Conclusion: Selective venesection reduces the remote organ injuries of the ischaemic-reperfusion phenomenon.
|Title:||New Hope for an Old Cure: A Pilot Animal Study on Selective Venesection in Attenuating the Systemic Effects of Ischaemic-Reperfusion Injury|
|Keywords:||Acute ischaemia, Humoral factors, MODS, Pulmonary oedema, LOWER-LIMB ISCHEMIA, ACUTE MYOCARDIAL-INFARCTION, INFLAMMATORY RESPONSE, ISCHEMIA/REPERFUSION INJURY, PULMONARY-FUNCTION, ORGAN DYSFUNCTION, ENDOTHELIAL-CELLS, VISCERAL ISCHEMIA, VASCULAR-SURGERY, XANTHINE-OXIDASE|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)|
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