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July 1967

Augmentation of Arterial Collateral Blood Flow

Author Affiliations

Sao Paulo, Brazil; Chicago
From the departments of surgery of the Faculdade de Medicina da Universidade de Sao Paulo (Dr. Moraes) and the Northwestern University School of Medicine, Chicago.

Arch Surg. 1967;95(1):49-53. doi:10.1001/archsurg.1967.01330130051010

Still, if microcirculation fails, tissue nutrition is impaired and cardiovascular repair becomes futile.—deTakats1

PERIPHERAL tissue oxygenation is poor in patients with single or multiple arterial occlusions which produce symptomatic ischemia. Distal blood flow is sluggish, the viscosity of capillary blood is increased, and the arteriolar pressure decreased. A self-perpetuating cyclic worsening of the ischemia develops and progresses until tissue necrosis supervenes.

When distal arterial reconstruction is anatomically impossible or physiologically unsupportable, indirect means of augmenting microcirculatory flow becomes desirable. Heparinization has been utilized and found to be effective in forestalling irreversible tissue necrosis. Administration of dextran 40 has been utilized and shown to be beneficial by some in treatment of acute arterial occlusion.2 Similarly, vasospastic and traumatic ischemia has been favorably influenced by infusion of dextran 40.3 Even the ischemia of fat embolism has been satisfactorily treated using low molecular weight dextran.4

However, these clinical

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