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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.