Perioperative vascular flushing perfusion in acute mesenteric artery occlusion

Aim: To evaluate in animals and patients a perioperative vascular flushing perfusion with antioxidants in order to improve postischaemic condition of the bowel and hence, to prolong the warm ischaemia tolerance time. Materials: 40 rats and 10 patients with acute mesenteric artery occlusion. Methods: Intestinal ischaemia was induced in 40 rats by clipping the superior mesenteric artery for 1 h. Thirty animals received a vascular flushing perfusion with oxygen radical scavengers (ascorbate, tocopherol or oxypurinol). Histology, ATP, ADP levels were examined in tissue biopsies and malondialdehyde, lactate dehydrogenase, alkaline phosphatase levels were measured in blood during ischaemia and 60 min after reperfusion. Results: ATP restoration was particularly improved in the oxypurinol group (ATP/ADP-ratio = 2 vs. 1·2 in the control group). Malondialdehyde increase observed after reperfusion as a marker of radical induced lipid destruction was significantly attenuated (control group 160% of base level vs. 127% in the ascorbate group, 133% in the tocopherol group, 121% in the oxypurinol group). Histological alterations during ischaemia/reperfusion were markedly less extensive in the perfusion groups than in control. The patients treated perioperatively with arterial flushing perfusion had an overall mortality of 10%. Conclusion: Vascular flushing perfusion with oxygen radical scavengers prevents radical induced ischaemic damage and may prolong the warm ischaemic tolerance time of the intestine.