Ischemia-Reperfusion in Vascular Surgery

  • G. R. Novelli
  • C. Adembri
  • E. Gandini


Many complications occurring in patients submitted to vascular surgery can be attributed to ischemia-reperfusion (I-R) that accompanies vessels clamping and declamping (1). A growing body of evidence indicates that the pathogenesis of I-R can be ascribed to the unbalanced oxygen radical (0R°) generation occurring at reperfusion, when molecular O2 becomes available (2–4). This process is known as “oxygen paradox”.


Xanthine Oxidase Ischemia Reperfusion Neutrophil Infiltration Human Skeletal Muscle Aortic Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Novelli GP, Adembri C, Brunelleschi S, Livi P, Rossi R, Pratesi C (1990) Oxygen-radicals production during ischemia-reperfusion of the lower limbs in man: inhibitory effects of L-carnitine. Curr Ther Res 48:903–911Google Scholar
  2. 2.
    Odeh M (1991) The role of reperfusion-induced injury in the pathogenesis of the crush syndrome. N Engl J Med 324:1417–1422PubMedCrossRefGoogle Scholar
  3. 3.
    Rabl H, Khoschsorur G, Colombo T, Tatzber F, Esterbauer H (1992) Human plasma lipid peroxide levels show a strong transient increase after successful revascularization operations. Free Radic Biol Med 13:281–288PubMedCrossRefGoogle Scholar
  4. 4.
    Grace PA (1994) Ischaemia-reperfusion injury. Br J Surg 81:637–647PubMedCrossRefGoogle Scholar
  5. 5.
    Korthuis RJ, Smith JK, Carden DL (1989) Hypoxic reperfusion attenuates postischemic microvascular injuries. Am J Physiol 256:H315–319PubMedGoogle Scholar
  6. 6.
    Ferreira RF, Milei J, Llesuy S, Flecha BG, Hourquebie H, Molteni L, De Palma C, Paganini A, Scervino L, Boveris A (1991) Antioxidant action of vitamins A and E in patients submitted to coronary artery bypass surgery. Vase Surg 25:191–195Google Scholar
  7. 7.
    Abadie C, Baouali AB, Maupoil V, Rochette L (1993) An alpha-tocopherol analogue with antioxidant activity improves myocardial function during ischemia reperfusion in isolated working rat hearts. Free Radic Biol Med 15:209–215PubMedCrossRefGoogle Scholar
  8. 8.
    Campo GM, Squadrito F, Ioculano M, Altavilla D, Calapai G, Zingarelli B, Scuri R, Caputi AP (1994) Reduction of myocardial infarct size in rat by IRFI-048, a selective analogue of vitamin E. Free Radic Biol Med 16:427–435CrossRefGoogle Scholar
  9. 9.
    Kortuis RJ, Grisham MB, Granger DN (1988) Leukocyte depletion attenuates vascular injury in post-ischemic skeletal muscle. Am J Physiol 254:H823–827Google Scholar
  10. 10.
    Weselcouch CD, Grove RI, Demusz CD, Baird AJ (1991) Effect of in vivo inhibition of neutrophil adherence on skeletal muscle function during ischemia in ferrets. Am J Physiol 261:H1178-H1183PubMedGoogle Scholar
  11. 11.
    Novelli GP, Fantozzi R, Livi P, Adembri C, Vanni L, Pieraccioli E, Pratesi C (1988) Generazione di anione superossido nella ischemia chirurgica degli arti inferiori. Acta Anaesth Ital 39:323–331Google Scholar
  12. 12.
    Formigli L, Domenici-Lombardo L, Adembri C, Brunelleschi S, Ferrari E, Novelli G (1992) Ischemia-reperfusion of human skeletal muscle: a role for neutrophils. Hum Pathol 23:627–634PubMedCrossRefGoogle Scholar
  13. 13.
    Adembri C, Formigh L, Ibba-Manneschi L, Gandini E, Zecchi-Orlandini S, Novelh G (1993) Neutrophil-endothelial cell interactions in I-R of human skeletal muscle. Minerva Anestesiol 59 [Suppl 2]:46Google Scholar
  14. 14.
    Formigh L, Ibba-Manneschi L, Adembri C, Zecchi Orlandini S, Pratesi C, Novelh GP (1995) Expression of E-selectin in ischemic and reperfused human skeletal muscle. Ultrastruct Pathol 19:193–200CrossRefGoogle Scholar
  15. 15.
    Draper HH, Hadley M (1990) Malondialdehyde determination as index of lipid peroxidation. Methods Enzymol 186:421–431PubMedCrossRefGoogle Scholar
  16. 16.
    Adembri C, Gandini E, Papucci L, Pieraccioli E, Rossi R, Vannucci F, Capaccioli S, Novelli GP (1994) Abdominal aortic crossclamping provokes oxidative stress of skeletal muscle as assessed by malondialdehyde. Minerva Anestesiol 60 [Suppl 2]:411Google Scholar
  17. 17.
    Novelli GP, Adembri C, Gandini E, Zecchi Orlandini S, Papucci L, Formigli L, Ibba-Manneschi L, Quattrone A, Pratesi C, Capaccioli S (1995) Vitamin E protects human skeletal muscle from damage during surgical ischemia-reperfusion. Am J Surg (submitted)Google Scholar
  18. 18.
    Scardi S, Rossi R, Pieraccioli E, Tani R, Novelli GP (1993) Reduced glutathione prevents lipid peroxidation as expressed by ethane exhalation during aortic surgery in man. Minerva Anestesiol 59 [Suppl 2]:215Google Scholar
  19. 19.
    Kneepkens CMF, Lepage G, Roy CC (1994) The potential of the hydrocarbon breath test as a measure of lipid peroxidation. Free Radic Biol Med 17:127–160PubMedCrossRefGoogle Scholar
  20. 20.
    Stallone RJ, Lim RC, Blaisdell FW (1969) Pathogenesis of the pulmonary changes following ischemia of the lower extremities. Ann Thorac Surg 7:539–549PubMedCrossRefGoogle Scholar
  21. 21.
    Anner H, Kaufman RP, Kobzik L et al (1987) Pulmonary leukosequestration induced by hind limb ischemia. Ann Surg 206:162–167PubMedCrossRefGoogle Scholar
  22. 22.
    Klausner JM, Paterson IS, Mannick JA et al (1989) Reperfusion pulmonary edema. JAMA 261:1030–1035PubMedCrossRefGoogle Scholar
  23. 23.
    Rossi R, Fortunati B, Mediati RD, Girardi G, Pieraccioli E, Tani R, Novelli GP (1993) Preoperative high dose alfa-tocopherol prevents the increase of extravascular lung water during ischemia and reperfusion in man. Minerva Anestesiol 59 [Suppl 2]:216Google Scholar
  24. 24.
    Chow CK (1991) Vitamin E and oxidative stress. Free Radic Biol Med 11:215–232PubMedCrossRefGoogle Scholar
  25. 25.
    Adembri C, Gandini E, Formigli L, Papucci L, Novelli GP (1995) Protection afforded by vitamin E against ischemia-reperfusion damages in human skeletal muscle. Minerva Anestesiol (submitted)Google Scholar
  26. 26.
    Formigh L (1995) Critical events on endothelial surface during ischemia-reperfusion in man. Exp Pathol Practice (submitted)Google Scholar
  27. 27.
    Mediati RD, Girardi G, Rossi R, Pieraccioli E, Tani R, Novelli GP (1993) Glutathione administration prevents the increase of extravascular lung water during ischemia and reperfusion in man. Minerva Anestesiol 59 [Suppl 2]:214Google Scholar
  28. 28.
    Smith JK, Grisham MB, Granger DN, Korthuis RJ (1989) Free radical defense mechanisms and neutrophil infiltration in post-ischemic skeletal muscle. Am J Physiol 256:H789–793PubMedGoogle Scholar
  29. 29.
    Ciuffetti G, Mercuri M, Mannarino E, Lombardini R, Pasqualini L, Ott C, Lupatelli G (1991) Are leukocyte-derived free radicals involved in ischaemia of human legs? Eur J Clin Pharmacol 21:111–117Google Scholar
  30. 30.
    Romson JL, Hook BG, Kunkel SL et al (1983) Reduction of extent of acute myocardial injury by neutrophil depletion in the dog. Circulation 67:1016–1023PubMedCrossRefGoogle Scholar
  31. 31.
    Korthuis RJ, Grisham MB, Granger DN (1990) Leukocytes depletion attenuates vascular injury in postischemic canine skeletal muscle: role of granulocyte adherence. Circ Res 66:1436–1444PubMedGoogle Scholar
  32. 32.
    Dorion D, Zhong A, Chiù C, Forrest CR, Boyd B, Pang CY (1993) Role of xanthine oxidase in reperfusion injury of ischemic skeletal muscle in the pig and human. J Appl Physiol 75: 246–255PubMedGoogle Scholar
  33. 33.
    Jarasch ED, Bruder G, Heid HW (1986) Significance of xanthine oxidase in capillary endothehal cells. Acta Physiol Scand [Suppl] 548:39–46Google Scholar
  34. 34.
    Palluy O, Morilere L, Gris JC, Bowne C, Modat G (1992) Hypoxia/reoxygenation stimulates endothelium to promote neutrophil adhesion. Free Radic Biol Med 13:21–30PubMedCrossRefGoogle Scholar
  35. 35.
    Bulkley GB (1994) Reactive oxygen metabolites and reperfusion injury: aberrant triggering of reticuloendothelial function. Lancet 344:934–936PubMedCrossRefGoogle Scholar
  36. 36.
    Kubes P, Suzuki M, Granger DN (1991) Nitric oxide: an endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci USA 88:4651–4655PubMedCrossRefGoogle Scholar
  37. 37.
    Gaboury J, Woodman RC, Granger DN et al (1993) Nitric oxide prevents leukocyte adherence: role of superoxide. Am J Physiol 265:H862–867PubMedGoogle Scholar
  38. 38.
    Tsao PS, Aoki N, Lefer DJ et al (1990) Time course of endothelial dysfunction and myocardial injury during myocardial ischemia and reperfusion in the cat. Circulation 82:1402–1412PubMedCrossRefGoogle Scholar
  39. 39.
    Mugge A, Elwell JH, Peterson TE et al (1991) Release of intact endothelium-derived relaxing factors depends on endothelial superoxide dismutase activity. Am J Physiol 260:C219–225PubMedGoogle Scholar
  40. 40.
    Rubanyi GM, Ho EH, Cantor EH et al (1991) Cytoprotective function of nitric oxide: activation of superoxide radicals produced by human leukocytes. Biochem Biophys Res Commun 181:1392–1397PubMedCrossRefGoogle Scholar
  41. 41.
    Gandini E, Adembri C, Formigli L, Papucci L, Novelli GP (1995) Peroxidative damage observed in human skeletal muscle after ischemia-reperfusion are related to duration of ischemia. Minerva Anestesiol (submitted)Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • G. R. Novelli
  • C. Adembri
  • E. Gandini

There are no affiliations available

Personalised recommendations