Improvement of small intestinal microcirculation by postconditioning after lower limb ischemia

• We assess remote small bowel injury after infrarenal aortic occlusion.
• Significant reduction in superior mesenteric artery flow was detected.
• Microcirculation of the three bowel segments showed considerable impairment.
• The degree of histological damage correlates well with microcirculatory damage.
• Postconditioning is able to reduce the degree of remote small bowel injury.

BackgroundMajor lower limb vascular surgeries may result in severe, remote injury of the gastrointestinal system, which has high mortality rates. Postconditioning is a technique with potential capability of reducing remote gastrointestinal complications. Our aim was to assess the remote macro- and micro-hemodynamic changes of the small intestine following an infrarenal aortic occlusion and to evaluate the effects of postconditioning on these alterations.MethodsRats underwent 3 h of infrarenal aortic occlusion followed by 4 h of reperfusion. In one group, postconditioning was applied. Blood pressure, superior mesenteric artery flow and mucosal microcirculation of the duodenum, jejunum and ileum were assessed. Samples were taken from each intestinal segment for histological examinations.ResultsSuperior mesenteric artery flow, as well as microcirculation of the duodenum, jejunum and ileum showed significant impairment in the IR group, while histological damage was significantly worsened. Postconditioning was able to limit flow reduction in all three small bowel segments and in the superior mesenteric artery, and was able to significantly reduce histological damage. Strong negative correlation was found between microcirculatory values and histological damage.ConclusionsMicrocirculatory impairment might be responsible for remote intestinal injury following infrarenal aortic occlusion. Postconditioning was able to reduce this remote intestinal damage.