The tourniquet revisited as an adjunct to lower limb revascularization

• Published in: Journal of vascular surgery 2000-03, Vol.31 (3), p.436-442
• Main Authors: CIERVO, A, DARDIK, H, FENG QIN, SILVESTRI, F, WOLODIGER, F, HASTINGS, B, LEE, S, PANGILINAN, A, WENGERTER, K
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Case-Control Studies; Female; Humans; Ischemia - surgery; Leg - blood supply; Male; Medical sciences; Muscle, Skeletal - pathology; Popliteal Artery - surgery; Reperfusion Injury - enzymology; Reperfusion Injury - pathology; Saphenous Vein - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tourniquets; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2000.103798

The purpose of this study was to evaluate the role and efficacy of the tourniquet in lower limb revascularization. During a 3-year period, 195 patients underwent 205 infrainguinal reconstruction operations in the lower extremity. These patients underwent bypass with a tourniquet and inflow occlusion (group 1) or bypass without a tourniquet (group 2). The type of infrainguinal reconstruction, tourniquet ischemia time, blood loss, and complications related to tourniquet use were recorded. A subset of patients underwent serial muscle biopsies. Specimens from calf muscle were taken just (1) before application of the tourniquet, (2) before tourniquet release, and (3) once wound closure was initiated. These biopsy specimens were studied by histochemical staining and also analyzed for phosphorylase enzyme, a marker for subcellular ischemia. One hundred eleven patients underwent 117 infrainguinal reconstruction procedures in which the tourniquet and inflow occlusion were used. These patients were matched against 84 patients who underwent 88 infrainguinal reconstructions without the use of the tourniquet. Complete hemostatic control in group 1 was obtained in 108 of the procedures (92%). Eight percent of the procedures required minor additional techniques to obtain complete hemostasis; in two instances, the tourniquet was removed because it did not provide hemostasis. Mean tourniquet time was less than 1 hour for all reconstruction groups. There were no instances of neurologic deficit, thrombosis of distal vessels, or vascular injury that was related to the use of a tourniquet. A comparison of the two groups revealed no differences with regard to overall blood loss (P =.63) or duration of operation (P = 0.60), observations that reflect the complexity of the cases rather than the use or nonuse of a tourniquet. When tourniquet control was used, we noted a definite decrease in the time for the distal dissection, because total vascular control with extensive dissection was unnecessary. Histochemical analysis with phosphorylase revealed a conversion of tissue with active enzyme activity to a low level with tourniquet use (P