Revision periarterial sympathectomy for recurrent digital ischaemia: a report with 11 patients

Following periarterial sympathectomy, patients with recurrent digital ischemia due to vasospastic or vaso-occlusive disease have few remaining treatment options. We performed a retrospective review from 1997 to 2019 to determine the safety and efficacy of revision periarterial sympathectomy. Eleven patients were identified who underwent revision periarterial sympathectomy, performed on average 84 months after their initial procedure. Preoperatively, all patients had worsening ischemic pain and five had non-healing digital ulcers. Revision digital periarterial sympathectomy alone was performed in seven patients, while four had a more extensive sympathectomy. Mean follow-up after revision was 23 months (range 3 to 76). Eight patients had symptomatic improvement and four healed their digital ulcers. Three patients developed new ulcers during follow-up, of which two healed with conservative management and one required three digital amputations. Revision periarterial sympathectomy is effective in providing symptomatic improvement and digital ulcer healing with minimal postoperative complications. Level of evidence: IV

Possible Therapeutic Options for Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) describes an array of painful conditions that are characterized by continuing regional pain. CRPS comprises severe and inappropriate pain in cases of complete recovery after trauma. Research on the pharmacological treatment of CRPS, however, has not been well investigated. In this study, we compared the pain relief effects of different drugs (URB597, pyrrolidine dithiocarbamate, and hydralazine) in a rat model of chronic post-ischemic pain-induced CRPS. After drug injection, CRPS-induced mechanical allodynia was significantly recovered. After three repetitive drug injections, mechanical sensitivity generally improved as hyper-nociception subsided. Reduced Nav1.7 expression at dorsal root ganglions (DRGs) was observed in the drug treatment groups. Neural imaging analysis revealed decreased neural activity for each drug treatment, compared to vehicle. In addition, treatments significantly reduced IL-1β, IL-6, and TNFα expression in DRGs. These results indicated that drugs could reduce the expression of inflammatory factors and alleviate the symptoms of chronic post-ischemic pain-induced CRPS.

Location of ischemia and ischemic pain intensity affect spatiotemporal parameters and leg muscles activity during walking in patients with intermittent claudication

The ways in which locations of ischemia and ischemic pain affect spatiotemporal gait parameters and leg electromyographic activity during walking have never been investigated in patients with peripheral arterial disease presenting intermittent claudication. Two groups were classified according to unilateral location of ischemia (distal, n = 10, or proximo-distal, n = 12). Patients described pain and three gait phases—initial pain-free, onset of pain and maximum pain—were analyzed. Patients with proximo-distal ischemia walked less (230 ± 111 m vs 384 ± 220 m), with increased step length, step time (+ 5.4% and + 5.8%) and reduced cadence (− 8.2%), than patients with distal ischemia. In both, the peaks of vertical ground reaction force were reduced in maximum pain (Peak1-distal: − 11.4%, Peak1-proximo-distal: − 10.3%; Peak2-distal: − 11.8%, Peak2-proximo-distal: − 9.0%). In the proximo-distal group, tibialis anterior activation peak and time were lower than in the distal group (− 4.5% and − 19.7%). During the maximum pain phase, this peak decreased only in the proximo-distal group (− 13.0%), and gastrocnemius medialis activation peak and time decreased in both groups (− 2.5% in distal and − 4.5% in proximo-distal). Thus, proximo-distal ischemia leads to more adverse consequences in gait than distal ischemia only. Increasing ischemic pain until maximum, but not onset of pain, induced gait adaptations.

Organoprotection in patients with COVID-19

Background. Treatment of chronic coronary syndrome (CCS) includes the elimination of acute ischemic pain, prevention of ischemic pain, symptomatic treatment, and influence on the prognosis. The health of patients with CCS during their lifetime is affected by the diet, climate, medication, exposure to toxic substances, and now the COVID-19 epidemic. Objective. To describe the available options of cardioprotection and metabolic therapy. Materials and methods. Analysis of literature data on this topic and own research “Smart ECG”. Results and discussion. A significant number of the foreign scientists’ papers have been devoted to the problems of the excessive release of free radicals, mitochondrial DNA damage, reduction of ATP content and cardiocytoprotection. Even the short-term ischemia depletes ATP depots and slows their recovery. Metabolic therapy is able to protect cardiomyocytes from the hypoxic death due to the mismatch of energy production by mitochondria to the energy needs of the cell. According to the results of the own study “Smart ECG”, L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) activates parasympathetic regulation in stable angina, reducing the risk of adverse events. Vascular, immunomodulatory, antioxidant and cytoprotective properties of L-carnitine and L-arginine make their use reasonable for COVID-19. Conclusions. 1. Metabolic therapy is an important component of the treatment of CCS. 2. L-carnitine and L-arginine have the pronounced vascular, immunomodulatory, antioxidant and cytoprotective properties. 3. It is reasonable to use these drugs during an epidemic of COVID-19.