[The reperfusion syndrome]

The syndrome of reperfusion is a succession of pathologic phenomena, developing at the level of a tissue that had suffered from an episode of acute ischemia and is then reperfused normally. The clinical phenomena present, characterized mainly by the appearance of an important local edema and of clear signs of tissular suffering, with sensory and motor nervous disturbances, lack of muscular contracture and, finally, phenomena of necrosis, are due to development at cellular level of some processes leading, during reperfusion and resuming of the oxygen contribution towards cells, to some chemical processes which generate an important activation of several systems with major tissular aggressiveness. The phenomena initiated locally produce here a secondary lesion that impairs the recovery of the ischemized territory, on the one hand, and the products generated in this territory activate similar phenomena in the distance, on the other hand. The primary wounded area becomes an important inflammatory focus which emits a series of mediators leading to the generalized activation of the nonspecific immune system. Both phenomena generate, in fact, a syndrome of multiple organic insufficiency that puts in danger the patient's life. Casuistics of 1506 interventions on patients with peripheral acute ischemic syndromes showed that the maximum mortality is given by tardy interventions of reperfusion (more than 12 hours) in which the syndrome of organic insufficiency appeared almost permanently.