Pharmocological Agents in Vascular Surgery



- See:
       - Aspirin
       - Heparin
       - Dipyridamole
       - Verapamil
       - Warfarin
       - Urokinase
       - Papaverine

- Prevention of Thrombosis in Microvascular Surgery:
    - most significant factor in patency of microvascular anastomoses is flawless surgical technique;
    - small pieces of adventia caught in the anastomosis provide a nidus for platlet thrombus formation;
    - leaking from of blood thru gap in suture line requires platlet thrombus to occulde the gap, which may extend into luminal wall;
    - more common is the problem caused by a suture that includes a portion of the back wall and thereby obstructs the lumen;
    - eversion of the suture with too large bite may also decrease diameter of the lumen and invites thrombus formation;
    - disappearance of pulse suggest development of thrombus at site of arterial repair, whereas rapid development of edema in extremity
           may be assoc w/ thrombosis at the site of the venous repair;

- Antiplatlet Agents:
    - antiplatlet drugs, ASA & dipyridamole, are used systemically for their ability to stabilize platlets;
    - aspirin and dypyridamole have a specific effect on inhibiting the release of adenosine diphosphate (ADP) in response to collagen;
    - 300 mg of ASA is given at surgery and daily therafter;
    - on vessel wall, Prostacyclin has beneficial effect of inhibiting platlet aggregation;
         - this effect is abolished by doses of ASA above 4.9 mg/kg
    - effect of aspirin on the platlet is inhibition of thromboxane, potent platlet aggregator;
         - doses below 3.2 mg/kg selectively inhibit thromboxane production on the platlet without interfering with prosta-cycline production in vascular endothelial cells;
    - dipyridamole has an additional vasodilator effect that lasts approximately 24 hrs; the dose is 100 mg PO tid;

- Heparin:
    - at present, no significant improvement in patency rates has been acheived with the prophylactic use of heparin



Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A mprospective randomized multi-center study.

Washout of vessels with heparin does not improve patency following severe microarterial trauma: an experimental study.

Beneficial effects of intra-arterial reserpine after upper-extremity embolectomy: a prospective randomised trial.

Intra-arterial thrombolytic therapy in peripheral vascular disease.

Evaluation of the effect of pharmacologic agents on crush-avulsion arterial injuries: a scanning electron microscopy study.

Oxygen-derived free radicals in postischemic tissue injury.

The effects of inhalation anesthetic agents on survival in a pig random skin flap model.

Involvement of reactive oxygen species in post-ischaemic flap necrosis and its prevention by antioxidants.

Nicotinamide enhances skin flap survival.

Deferoxamine attenuates ischemia-induced reperfusion injury in the skin and muscle of myocutaneous flaps in the pig.

A comparative analysis of the ability of five classes of pharmacological agents to augment skin flap survival in various models and species: an attempt to standardize skin flap research.

Ischaemia reperfusion injury in pedicle skin flaps in the pig: lack of protective effect of SOD and allopurinol.

The effects of allopurinol and superoxide dismutase in a rat model of skin flap necrosis.

The effects of pentoxifylline on random skin flap survival.

Fasciocutaneous flaps: an experimental model in the pig.

Pharmacologic manipulation of random skin flaps with pentoxifylline.

A comparative study on the effect of various pharmacological agents on the survival of skin flaps in the rat.

Involvement of reactive oxygen species in post-ischaemic flap necrosis and its prevention by antioxidants.

Tissue oxygen tension in random pattern skin flaps during normovolemic hemodilution.

Augmentation of critical skin flap survival following ibuprofen therapy.

A comparative study of skin blood flow in musculocutaneous and random pattern flaps.

Drug treatment and flap survival.

Experimental study of the influence of arterial trauma on dependent distal tissue survival.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, May 11, 2012 12:48 pm