Hypertensive extracorporeal limb perfusion (HELP): A new technique for managing critical lower limb ischemia Rodney J. Lane, MD, Mark Phillips, PhD,

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Presentation transcript:

Hypertensive extracorporeal limb perfusion (HELP): A new technique for managing critical lower limb ischemia Rodney J. Lane, MD, Mark Phillips, PhD, Darryl McMillan, CCP, Matt Huckson, MEng, Samuel Wei-Unn Liang, MBiomed E, Michael Cuzzilla, DMU Vasc Journal of Vascular Surgery Volume 48, Issue 5, Pages 1156-1165 (November 2008) DOI: 10.1016/j.jvs.2008.05.085 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 A schematic representation of regional limb hyperperfusion. The superficial femoral artery has been ligated. Pump inflow comes from the external iliac artery under negative pressure. The limb was isolated with an inflated balloon. Pump outflow hyperperfused the collaterals via the profunda femoris artery. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Delivery and access device (PAS. A schematic showing the transcutaneous tube with the blood flow directions indicated by arrows. The inflated balloon isolates the systemic circulation from the limb. The plunger is shown in compressed form and the cardiac pump is not shown. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 The PAS with pump connections. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Hyperperfusion treatment compared with controls. This graph shows the change in relative femoral blood pressure over the experimental time (240 minutes). The ratio of femoral pressure to carotid pressure was used as the measure because it controls for normal variations in the sheep systemic blood pressure during the experiment. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Angiogram of the leg revealing interrupted flow in the popliteal artery. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 6 Pressure and flow measurements of both hyperperfusion treatments showing a continuously decreasing trend in pressure with a slight increase in overall blood flow. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 7 Thermographic study of patient FW with an ischemic left lower limb. In (a), the patient is resting, off-pump while (b), (c), (d) demonstrate skin perfusion during the hyperperfusion phase. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 8 Thermographic study of (a) of left lower limb tibial line of Patient MB eight months post-hyperperfusion compared to the normal contralateral limb (ankle brachial index >1.0). Skin blood flow on the treated leg was superior as demonstrated in (b) when compared to the “normal” limb. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 9 Patient pain level (1-10) and timeline. The arrows indicate “on pump” periods. Journal of Vascular Surgery 2008 48, 1156-1165DOI: (10.1016/j.jvs.2008.05.085) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions