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Hypertonic MannitolIts Use in the Prevention of Revascularization Syndrome After Acute Arterial Ischemia
Dale Buchbinder, MD, MS;
Allastair M. Karmody, MD;
Robert P. Leather, MD;
Dhiraj M. Shah, MD
Arch Surg. 1981;116(4):414-421.
Abstract
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• Revascularization of acutely ischemic lower limbs is associated with high mortality and high rates of rethrombosis, limb loss, massive edema, and compartment syndrome. These complications may be due to revascularization syndrome. The effects of hypertonic mannitol used during revascularization of acutely ischemic lower extremities were studied. In an isolated canine hind limb model, revascularization of the limb via a Dacron graft after 90 minutes of ischemia resulted in tissue edema and decreased flow. The low flow state (50% of control) for two hours after reperfusion was associated with thrombosis at the anastomosis. Use of hypertonic mannitol reversed the reperfusion syndrome and prevented graft thrombosis. Therefore, 15 consecutive patients with acute lower extremity ischemia and threatened limb loss were treated with hypertonic mannitol during emergency thromboembolectomy. Fourteen patients survived and had excellent results without any rethrombosis. Compartment syndrome was absent. Results of this clinical trial suggest that hypertonic mannitol may be useful in the management of acute arterial ischemia.
(Arch Surg 1981;116:414-421)
Author Affiliations
From the Department of Surgery, Albany Medical College and Veterans Administration Medical Center, Albany, NY.
Footnotes
Accepted for publication Nov 5, 1980.
Read at the Fourth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Alexandria, Va, May 12, 1980.
Reprint requests to Department of Surgery (112), VA Medical Center, Albany, NY, 12208 (Dr Shah).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Acute Lower Extremity Ischemia and Reperfusion Injury
Kempczinski
PERSPECT VASC SURG ENDOVASC THER 1989;2:75-84.
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