Therapeutic option for managing lung injury induced by infrarenal aortic cross-clamping David Garbaisz, MD, a Zsolt Turoczi, MD, a Andras Fulop, MD, a Oliver Rosero, MD, a Peter Aranyi, MD, a Peter Onody, MD, a Gabor Lotz, MD, PhD, b Zoltan Rakonczay, MD, PhD, c Zsolt Balla, c Laszlo Harsanyi, MD, PhD, a and Attila Szijarto, MD, PhD a, * a 1 st Department of Surgery, Semmelweis University, Budapest, Hungary b 2 nd Department of Pathology, Semmelweis University, Budapest, Hungary c 1 st Department of Medicine, University of Szeged, Szeged, Hungary article info Article history: Received 11 March 2013 Received in revised form 30 April 2013 Accepted 3 May 2013 Available online xxx Keywords: Ischemia-reperfusion Lower limb Postconditioning Systemic inflammatory response syndrome Lung damage ARDS abstract Background: Operations on the infrarenal aorta can cause ischemic-reperfusion (IR) injury in local tissues, which could result in remote organ (e.g., lung) damage. Treatment of such injuries remains an unresolved problem. Objectives: Our aim was to reduce remote lung damage after lower limb IR by means of postconditioning. Materials and methods: Male Wistar rats were divided into three groups: Sham-operated, IR, and Postconditioned (PostC). In the latter two groups rats underwent 180 min of exclusion of the infrarenal aorta. The reperfusion time was 4 h. Serum-free radical levels, tumor necrosis factor-a and interleukin-6 concentrations, histologic changes in the lung, wet/dry- ratio, myeloperoxidase activity, heat shock protein 72 level and blood gas changes were investigated. Results: Postconditioning reduced histological damage in the lung (P < 0.05). Free radical levels and tumor necrosis factor-a concentrations were significantly lower in the PostC group than in the IR group (P < 0.05 and P < 0.01, respectively). Interleukin-6 concentrations did not significantly differ in the PostC group. Compared with the IR group, lung myelo- peroxidase activity was lower in the PostC group. Decreased pulmonary heat shock protein 72 level was observed in the PostC group compared with the IR group and the wet/dry-ratio was also significantly lower in the PostC group (P < 0.05). A noticeably higher arterial pO 2 level was manifest in the PostC group after 2 and 4 h of reperfusion (P < 0.05). Conclusions: Postconditioning reduced lung damage under experimental conditions, in the early period of reperfusion after lower limb IR injury. ª 2013 Elsevier Inc. All rights reserved. 1. Introduction During major infrarenal vascular operations on the lower limb, the tissue suffers ischemic-reperfusion (IR) injury, especially in surgical interventions involving prolonged ischemic periods. IR injury can be considered as a “double-edged sword,” since in a paradoxical manner, restoration of the blood supply exaggerates the already existing ischemic damage in the local muscle tissue. In addition to local complications, such as muscle cell necrosis, rhabdomyolysis, or compart- ment syndrome, remote organ injury may also develop, as * Corresponding author. 1 st Department of Surgery, Semmelweis University, 78. U ¨ llTi St., Budapest 1082, Hungary. Tel.: þ6 20 825 89 25; fax: þ6 20 825 21 62. E-mail address: szijartoattila@gmail.com (A. Szijarto). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research xxx (2013) 1 e8 0022-4804/$ e see front matter ª 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2013.05.022