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Significance of hemorrheology in the management of the ischemic limb

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Abstract

Clinicians have become interested in hemorrheologically oriented treatment of limb ischemia because of the increasing evidence that (a) hemorrheological abnormalities play an important role in the pathophysiology of circulatory diseases, and (b) such treatment may also be useful in the management of ischemia due to other causes. Possible hemorrheological approaches to management of limb ischemia can be classified according to the primary hemorrheological determinant being treated: the red cell concentration, plasma proteins, or the flow properties of individual red cells. Hemodilution, difibrinogenation with an oral agent, and the use of drugs to improve red cell deformability represent possible therapeutic approaches. The feasibility, advantages, and shortcomings of each of these treatment modalities are explored.

Résumé

Les cliniciens accordent de l'intérÊt à l'action thérapeutique susceptible d'Être exercée sur les facteurs sanguins au cours de l'ischémie des membres depuis que s'affirme le rÔle de ces facteurs dans la physiopathologie des maladies circulatoires.

Le traitement prend en ligne de compte la concentration des hématies, les protéÏnes plasmatiques et le flux des cellules rouges. De ce fait, l'hémodilution, la défibrinogénation avec un agent oral, l'emploi de drogues capables d'améliorer la déformation des hématies constituent des possibilités thérapeutiques. La faisabilité, les avantages et l'action précoce de chacune de ces approches thérapeutiques sont étudiés.

Abstracto

Los médicos se han interesado en el tratamiento hemorreologicamente orientado de la isquemia de la pierna en virtud de la creciente evidencia de que: 1) las alteraciones hemorreológicas juegan un papel importante en la patofisiología de las enfermedades circulatorias, y 2) tal tratamiento también puede ser de utilidad en el manejo de isquemias de otras causas. Los posibles enfoques hemorreológicos del manejo de la isquemia de la pierna pueden ser clasificados de acuerdo al determinante hemorreológico primordial que está siendo tratado: la concentratión de glóbulos rojos, las proteínas plasmáticas o las propiedades de flujo de los glóbulos rojos individuales. La hemodilución, la defibrinogenación con un agente oral y el uso de drogas para mejorar la deformabilidad de los glóbulos rojos representan algunos posibles enfoques terapéuticos. Se exploran la factibilidad, ventajas y limitaciones de cada una de estas modalidades de tratamiento.

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  1. St. James's and St. George's Hospitals, London, England

    John A. Dormandy F.R.C.S.

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  1. John A. Dormandy F.R.C.S.
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Dormandy, J.A. Significance of hemorrheology in the management of the ischemic limb. World J. Surg. 7, 319–325 (1983). https://doi.org/10.1007/BF01658079

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