OBJECTIVE
To optimize methods of prevention and treatment of reperfusion syndrome after reconstructive surgeries on the arteries of the lower extremities with atherosclerotic changes.
MATERIALS AND METHODS
The study was based on the analysis of treatment in 75 patients who underwent reconstructive surgery of lower extremity arteries with atherosclerotic changes and grade IIB-IV ischemia according to Pokrovsky—Fontaine. The patients were divided into two groups comparable in age, sex, and comorbidities. Group 1 included 40 patients who received vasotropic therapy in the postoperative period, according to national guidelines for the treatment of obliterating atherosclerosis of the lower extremity arteries. Group 2 included 35 patients who received L-Lysine escinate 5.0 ml for 14 days, in addition to standard of care, after limb revascularization. Levels of lactate, myoglobin, creatinine, creatine phosphokinase (CPK), soluble fibrin monomer complexes (SFMC), D-dimer, and fibrinogen were monitored to comprehensively evaluate treatment effectiveness.
RESULTS
The study demonstrated a statistically significant improvement of key biochemical markers in the L-Lysine escinate1 group. The most pronounced changes were observed in the markers of tissue hypoxia and coagulation potential. The lactate level in the test group significantly decreased by 29.5% by Day 10 of observation (p<0.001), while no significant changes were observed in the comparison group (p=0.262). A significant improvement in SFMC levels was noted: a 29.5% decrease in the test group (p<0.001) and no change in the comparison group (p=0.940). Stabilization of the coagulation potential was confirmed by fibrinogen levels: in the test group, no significant changes were observed, whereas in the comparison group, a significant increase of 17.8% (p=0.003) was observed. In addition, in the test group, D-dimer increased by 2.2%, while in the comparison group, a tendency to increase by 9.8% was observed. The cytoprotective effect of therapy was supported by a 15.6% decrease in myoglobin in the test group and a 3.0% decrease in creatinine, compared with 12.2% in the comparison group. Study of venous hemodynamics showed a more physiological recovery of blood flow velocity in the test group, with a consistent decrease in blood flow velocity by 11.1% in the external iliac vein (EIV), by 12.4% in the common femoral vein (CFM), and by 16.9% in the popliteal vein (PV) on Day 3, with a subsequent tendency to normalization, in contrast to the abnormal increase in these markers in the comparison group by 8.0%, 8.0%, and 16.7%, respectively.
CONCLUSION
The use of L-lysine escinate in the postoperative period in patients after lower extremity arterial reconstructive surgery demonstrated high effectiveness in preventing reperfusion syndrome. Therapy exerted a complex effect on the key pathogenetic links of reperfusion damage, reduced tissue hypoxia (lactate decrease by 29.5%), normalized coagulation potential (SFMC decrease by 29.5%, change of fibrinogen and D-dimer levels), andshowed cytoprotective (stabilization of myoglobin levels) and organoprotective properties (stable creatinine levels). The obtained data support the use of L-lysine escinate in standard postoperative management regimens to reduce the frequency and severity of reperfusion syndrome. Monitoring the complex of biochemical markers (lactate, SFMC, D-dimer, fibrinogen, myoglobin, and creatinine) is a promising tool for early diagnosis and for assessing the effectiveness of preventive measures.
