The Experimental Study On Peripheral Artery Damage By Iohexol

Objective: Human arteries are widely distributed in various body tissuesand organs, providing the blood perfusion. The main arteries damage of thekey tissue and organ will seriously affect the blood supply of the arterialperfusion region,resulting in ischemic necrosis of the tissue or organ. With therapid development of industry, agriculture and transportation in recentyears,the human limbs damages were increasing year by year,and the rate ofteratogenic disability with high-energy injury was quite high,impactingseriously the working and living of the people.Meanwhile, the method ofangiography developed rapidly inthe diagnosis of vascular injury. Digitalsubtraction angiography (DSA) has been widely used in this area, becomingthe gold standard for diagnosiing vascular disease or injury and. Iohexol was akind of water-soluble, non-ionic contrast agent, becoming the first choice inclinical application. However, the application of contrast agents was notabsolutely safe in the process of angiography, uaually resulting in severalcomplications such as vascular injury，contrast nephropathy, allergic reactions,et al. In the process of iohexol application in clinical practice. Patients oftenpresented extremities pain and arterial beaded changes after angiography. Inthe operation of thumb reconstruction with free transplantation of the secondtoe, we often examined the dorsalis pedis artery with angiography. Theangiographic arteria dorsalis pedis was more liable to vasospasm than thosewithout angiography, and the lasting time of vasospasm was longer. It isconsidered that the solution of iohexol might lead to small and medium-sizedlimb arterials damage. For this purpose, we designed this study to verifywhether the iohexol could cause damage to small and medium-sized arteries ofthe body. The aim of this study was to provide some relevant experience forperipheral vascular angiography.Methods: 1Twenty-eight cases with (30fingers) thumb reconstruction with freetransplantation of the second toe in trabant were admitted from October2010to August2011. They aged from18years old to45-year-old with averageage of (29±12.4) years old. The same segment of foot dorsal artery wasoperated at the same time point in different day. For Group1, the operationtime was before contrast angiography; For Group2, the operation time was30minutes after contrast angiography. The peak systolic blood flow velocity wasdetected with the machine of Phillips (IU22) pulsed Doppler in the similartime, by the same operator, with drugs of the same batch and the samepharmaceutical factory in order to remove the interference in maximum. Thechanges of the peak systolic blood flow velocity between Group1and Group2was compared.230finger swere choosed at the emergency stump prosthesis, to choose3-5mm of the intact part of arterial circulus vasculosus proximal part of thedamaged tissue. Cut the artery quickly wtth the keenness4℃f orecooling blade,and then douse the arterial circulus vasculosus into the60%W/V iohexolsolution for1minute, then fix them with glutaraldehyde. The specimens inglutaraldehyde was fixed immediately. The specimens was sent to the electronmicroscope laboratory for morphological observation.Results:28cases （30fingers）of the thumb reconstruction by the secondtoe free transplantation successfully survived with the wound healing of stageⅠ. One case was found vascular spasm and embolization, and the thrombuswas removed. Results:1. Before and30min after the angiography surgery, thepulse Doppler velocimetry showed that the peak systolic velocity of dorsalispedis artery decreased obviously after angiography with the use of Iohexol.There was a significant difference between the preoperative speed and thepostoperative speed (p<0.05).2. Histological observation of the transmissionelectron microscopy (magnification7.5k×and15.0k×) indicated that after theangiography on peripheral vascular tissue by iohexol, it is thus evident that:(1)The number of mitochondrial crista decreased or disappeared, and some of themitochondria became vacuolus.(2) Some of the vascular endothelial cells nucleus shrinked, and the shape of the nucleus was irregular. In addition,pinocytotic vesicles of the endothelial cell increased.(3) Diastem between theendothelial cells became larger than before.(4) Only a little part of thevascular endothelial cells connected to the base, part of the cell bodyshrinkaged, turnup or even fell off.Conclusions: In this study, two aspects were validated, including thechange of blood flow rate about human peripheral arteries pre/post operativeof angiography and electronmicroscope morphology observation.1human peripheral arterial vasospasm could be caused by Iohexol whichmight lead to the decrease of arterial blood flow velocity, resulting in thearterial perfusion area blood supply reduction and reducing the blood supplyto organs replantation or reconstruction.2Iohexol could cause various degrees of vascular intima damage and theirorganelles, increas the risk of vascular thrombosis, and reduce the rate ofrecanalization in vascular anastomosis surgery.3although the preoperative angiography can identify the blood vessels typeand provide guidance for the surgery, angiography should not be routinelyused in peripheral arterial damage detection and angeiguidance.4angiography was an invasive procedure, and it might cause a certain degreeof damage for the patients. The application of contrast agents could causevarious degrees of damages to peripheral vascular intimal cells of patients,especially aggravating the injury of these organs in patients with liver andkidney dysfunction and other high risk factors which might increase thepatient’s surgical risk.