The Analysis Of No-Reflow Phenomenon After Reperfusion In Patients With Chronic Limb Ischemia And Thrombosis

Objective : To analyze the relative factors of no-reflow phenomenon after reperfusion and the changes of prothrombotic state in patients with Chronic limb ischemia and thrombosis.Cases and Methods : From January 2009 to December 2010, the patients with Chronic limb ischemia and acute thrombosis of the First Affiliated Hospital of Chongqing Medical University were selected. 52 cases of male (58 limbs) and 7 cases of female (9 limbs),aged 46-94 years, the average age of 70.67±12.25 years. In accordance with the perioperative occurrence of no-reflow phenomenon ,the patients were divided into control group and the no-reflow group and then to analyze the relative factors of no-reflow phenomenon after lower limb arterial reconstruction. Logistic regression was employed to define the role of complications (diabetes, hypertension, cardiovascular diseases and smoking),the extend of ischemia, surgical,ischemia time on no-reflow phenomenon after ischemia reperfusion.Detect the changes of coagulation (including APTT, PT, INR, TT, FBG), platelet count (PLt) and prostaglandin (including TXA₂, PGI₂) in order to determine the in vivo prothrombotic state. Results:(1)The results of the logistic regression analysis showed that the no-reflow phenomenon group was 5.396 (1.445- 20.15) ,3.898( 1.331-11.4 1) ,4 .263( 2.280- 70.31 ) ,5.289 (1.153- 24.26) times more likely than the control group to have significantly elevated level of ischemia extent, ischemia time, smoking and diabetes. Surgical, high blood pressure and cardiovascular diseases were not statistically significant (P> 0.05).(2) Compared with the control group , the levels of plasma fibrinogen (fibrinogen, FBG), thromboxane A₂ (Thromboxane A₂, TXA₂) and T / P (TXA₂/PGI₂) in the no-reflow group patients were significantly increased .Prostacyclin I₂ (Prostacyclin I₂, PGI₂) was significantly lower and there was statistically significant difference (p<0.05). The differences among plasma prothrombin time (PT), part-time activation thromboplastin , (APTT), international ratio (INR), thrombin time (TT) and platelet count (Platelet count, PLT) were not statistically significant (P> 0.05).(3) TXA₂ level was correlated to FBG levels (P <0.05) in the correlation analysis and wsn't significant correlation to PLT, APTT, PT, INR and TT (P> 0.05). PGI₂ level isn't significant correlation to PLT, APTT , PT, INR and TT(P> 0.05).Conclusion:(1)Ischemia extent and ischemia time are the main factors of no-reflow phenomenon after reperfusion in patients with Chronic limb ischemia and acute thrombosis.(2)The patients combined with smoking or diabetes are at a high risk of occurring the no-reflow phenomenon .(3)Compared with the control group, Postoperative patients with no-reflow phenomenon are more severe prothrombotic state in viv , in which prostaglandins play an important role.