Timisoara Medical Journal – Effects of Electroacupuncture in Recently Operated Peripheral Arterial Disease Patients, Expressed by Ankle-Brachial Index. Pilot Study

REZUMAT
Obiectivul studiului a fost de a studia in ce masura se modifica indexul glezna-brat (IGB) la pacientii cu boala arteriala periferica cronica obstructiva, in prima saptamina post operator, printr-un tratament de electro-acupunctura (EA). S-a pornit de la premiza ca EA ar putea avea efecte similare cu cele obtinute de anestezia loco-regionala: diminuarea durerii si, in speta, prelungirea efectelor benefice ale simpatectomiei asupra circulatiei periferice. Material si metoda: in studiu au fost cuprinsi 40 de pacienti cu boala vasculara periferica (37 barbati si 3 femei), operati consecutiv in Institutul de Boli Cardiovasculare Timisoara, care au aceptat introducerea in studiu. in lot au fost cuprinsi 8 pacienti cu bypass aorto-bi-femural, doi cu ilio-femural si 30 de pacienti cu bypass femuro-popliteal. Tratamentul de acupunctura a constituit in electrostimularea unor puncte de acupunctura (P9, Pc6, St36 si Sp9), considerate a avea efecte hemodinamice in medicina traditionala chineza. Tensiunile arteriale au fost masurate si IGB calculate inainte de EA, la 5 minute si dupa 30 minute de la procedura. Cresterea IGB-ului a fost variabila, fiind cuprinsa intre 0,03 si 0,05 fata de valorile initiale. Rezultate: IGB creste la 5 min. post EA (p < 0,05) si se mentine partial si dupa 30 min. in lotul cu bypass femuro-popliteal la piciorul neoperat (p < 0,05). Concluzii: EA are efecte benefice si asupra perfuziei vasculare postoperator, la pacientii vasculari periferici, revascularizati chirurgical prin bypass-vascular.

ABSTRACT
Objective: The aim of the study was to observe the changes of the ankle-brachial index (ABI) in patients with peripheral artery disease (PAD), in the first week post-operatively, after having been submitted to electroacupuncture (EA). We started from the premises that EA could have similar effects to regional anesthesia, diminishing post-operative pain and improving peripheral circulation. Material and methods: 40 patients with PAD (37 male and 3 female) were enrolled in the study. They were consecutively operated at The Institute of Cardiovascular Diseases, Timisoara and accepted to participate to this study. The lot includes 8 patients with aorto-femoral by-pass, 2 patients with ilio-femoral by-pass, and 30 patients with femoro-popliteal by-pass. EA treatment consisted in electrical stimulation of acupuncture points (P9, Pc6, St36, and Sp9) considered in the Traditional Chinese Medicine (TCM) to influence the blood circulation in the human body. The blood pressure (BP) was measured and ABI calculated before EA and after the procedure at 5 and 30 minutes (min) respectively. Results: ABI increased at 5 min post EA (p > 0.05), and this increase was partially maintained after 30 min in the lot of the femuro-popliteal by-pass surgery patients at the non operated limb (p > 0.05). The degree of the ABI increase varied between 0.03 and 0.05 from baseline. Conclusion: EA has benefic effects on post-operative vascular perfusion, expressed by ABI, in the PAD patients who were subjects to revascularization surgery.

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How Much Malperfusion Is Too Much in Acute Type A Aortic Dissections?

REZUMAT
Despite contemporary advances in surgical technique and anesthetic management, mortality in acute Type A aortic dissection (AAAD) remains high, ranging from 15–30% [1,2,3], although there has been a constant trend to improve results over the last 20 years [4,5]. In the last decade, a focus on malperfusion has resulted in the establishment and subsequent validation of the Penn classification [6]. The presence of malperfusion can increase mortality to 29% [7], or even 43% if 3 or more systems are affected [8]. Some recent reports have argued for an “ischemia-first” approach, in which severe malperfusion is addressed prior to aortic repair [9,10,11,12]. On the other hand, the Stanford Group have recently published excellent results using the traditional “aorta-first” technique [13]. There are no studies determining the most sensitive marker for preoperative malperfusion. Lactic acid levels above 6 mmol/L [14], as well as base deficit greater than −10 mEq/L [15], have very recently been proposed as cutoff points for an unfavorable outcome, however none of these markers have been analyzed in conjunction with one another, as well as with preoperative pH. The purpose of this study was to identify preoperative malperfusion levels that would severely impact early and late survival by using an ‘’aorta-first” technique.

ABSTRACT
(1) Background: Malperfusion is a central limiting factor in the setting of acute Type A aortic dissections (AAAD). We sought to find preoperative metabolic acidosis thresholds that might influence decision-making in this setting. (2) Methods: We retrospectively reviewed consecutive patients operated on with AAAD between January 2002 and December 2017. We analyzed preoperative variables that might influence early and long-term outcomes, with particular emphasis on malperfusion markers. (3) Results: Our sample consisted of 153 patients, most of them male (69.2%), with a mean age of 55.89 ± 12.8 years. Malperfusion was present in 20.9% of cases: peripheric 25, renal 7, cerebral 4, and mesenteric 3. Cardiogenic shock was present in 18.9% of patients. Logistic regression revealed entry site (odds ratio (OR) = 2.83, p = 0.03), cardiogenic shock (OR = 3.30, p = 0.03), prebypass pH (OR = 0.93, p = 0.02) as independent risk factors for early death (<30 days). Receiver operating characteristic (ROC) analysis identified a prebypass pH of 7.25 as a cutpoint for an unfavourable early outcome. Patients whose prebypass pH was ≤7.25 had a 2.98 higher relative risk (65.7% vs. 22%, p < 0.001). Prebypass pH 7.25 (hazard ratio (HR) = 4.00, p < 0.01) and entry site (HR = 2.10, p = 0.04) were independent predictors of early phase survival (<30 days), while long-term survival (>30 days) was determined by age >65 years (HR = 3.12, p = 0.02). (4) Conclusions: Patients with a prebypass pH ≤ 7.25 have an unacceptably high early mortality after AAAD repair. Those patients might benefit from a two-stage approach.

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Timisoara Medical Journal – C-Reactive Protein in Recently Operated Peripheral Arterial Disease Patients and Treated with Electroacupuncture Postoperatively

REZUMAT
Obiective: Proteina C reactiva (CRP), reactant de faza acuta si marker independent al inflamatiei in ateroscleroza, a fost studiata pre si post chirurgical la pacientii cu boala arteriala periferica cronica obstructiva (BAPCO). Noi am investigat posibilitatea ca electroacupunctura (EA) sa influenteze evolutia valorilor plasmatice post operatorii ale CRP. Material si metode: in acest studiu au fost inclusi 50 de pacienti cu boala vasculara periferica, operati consecutiv cu by-pass femuro-popliteal la Institutul de Boli Cardiovasculare Timisoara si care au acceptat introducerea in studiu. EA a constat in electrostimularea urmatoarelor puncte de acupunctura: Neiguan (Pc 6), Zusanli (St 36), Sanyinjiao (Sp 6), Taiyaun (P 9), acestea fiind considerate a fi active in reglarea fluxului sanguin de catre medicina traditionala chineza. Lotul de pacienti tratat cu EA include 30 de pacienti iar lotul de control include 20 de pacienti. Rezultate: Ambele loturi au prezentat o crestere a valorilor CRP in ser. Acesti pacienti cu BAPCO se prezinta deja in preoperator cu valori medii crescute ale CRP in ambele loturi (lot acupunctura =10,79 mg/L si lot control =11,03 mg/L), din care 80% sunt peste 3 mg/L. Valorile medii ale CRP post operatorii sunt mai scazute in lotul tratat cu acupunctura comparativ cu lotul de control dar diferentele nu sunt semnificative statistic. Concluzii: Valorile plasmatice crescute ale CRP, mai mari de 3 mg/L pentru 80% din pacientii vasculari, sugereaza ca acestia au o forma mai severa de ateroscleroza cu un risc crescut de evenimente cardiovasculare. Tratamentul cu EA nu influenteaza semnificativ statistic valorile post operatorii ale PCR.

ABSTRACT
Objective: C- reactive protein (CRP), acute phase reactant and independent marker of inflammation in atherosclerosis, was observed pre and post-vascular surgery at patients with peripheral arterial disease (PAD). We searched for the possible influence of electroacupuncture (EA) therapy on postoperative CRP levels. Material and methods: Fifty consecutive patients with vascular by-pass surgery (revascularization by femoro-popliteal by-pass) performed at Timisoara Institute of Cardiovascular Medicine, during the period of July 2007- July. 2008, who gave their informed consent were enrolled in the study. EA treatment consisted in electro-stimulation for 30 minutes of the following acupuncture points: Neiguan (Pc 6), Zusanli (St 36), Sanyinjiao (Sp 6), Taiyaun (P 9). These are acupoints are considered active in blood flow regulation by traditional Chinese medicine (TCM). The acupuncture group consisted of 30 patients and the remainder 20 patients formed the control group. Results: Both study groups showed that surgery increase CRP, in the serum of the operated patients. These patients with PAD have their CRP preoperative levels already increased (means of 10.79 mg/L in the acupuncture group and 11.03 mg/L in the control group). The baseline CRP values are above 3 mg/L in 80% of the patients. Postoperative CRP mean levels are decreased in the EA group compared with control group, but there is no statistical significance. Conclusion: Elevated preoperative CRP > 3.0 mg/L for 80% of patients suggests that the PAD patients have a more severe atherosclerosis with a relative high risk for recurrent cardiovascular events. EA treatment does not influence significantly the postoperative CRP values.

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