[Effect of buflomedil perfusion on peripheral tissue oxygenation during transluminal angioplasty in patients with advanced arteriopathy of the lower limbs]. / Effet de perfusions de buflomédil sur l'oxygénation tissulaire périphérique au décours immédiat d'angioplasties endoluminales réalisées chez des patients souffrant d'une artériopathie évoluée des membres inférieurs.

Randomized double-blind placebo controlled trial performed in two parallel groups of patients, aged 43 to 92, suffering from advanced arterial disease of the lower limbs to be treated with angioplasty. The aim was to compare the efficacy of infusions of buflomedil with placebo on peripheral tissue oxygenation following lower limb angioplasties. Treatments consisted of 3 hour infusion of buflomedil or isotonic saline combined with arterial disobstruction. The major outcome measures were transcutaneous oxygen tension (TCpO2) correlated to ankle systolic pressure index (SPI). An increase of TCpO2 values (p < 0.01) as well as the mean individual variations of TCpO2 (p < 0.05) before and after angioplasty were observed in the buflomedil-treated group, whereas SPI values varied similarly in both groups. No adverse event was shown. In conclusion, buflomedil infusions during angioplasties of the lower limbs may improve tissue oxygenation subsequent to arterial disobstruction and are well tolerated.

Effect of buflomedil on in vitro prostacyclin and endothelin synthesis by vascular (rat and human) and penile (rat) tissue and calcium uptake by isolated human platelets.

The effect of buflomedil, a vasodilator, on: (a) in vitro prostacyclin (PGI2) synthesis by the rat aorta and penis, human cultured endothelial cells (HUVECs) and human iliac artery, (b) endothelin synthesis by HUVECs and (c) 45Ca2+ uptake by isolated human platelets was investigated. Buflomedil had no effect on PGI2 synthesis by rat aorta, iliac artery or HUVECs (short or long-term incubations). However, buflomedil inhibited noradrenaline- (but not arachidonate- or ionophore A23187-) stimulated PGI2 synthesis. Buflomedil had a weak stimulatory effect on PGI2 synthesis by the isolated rat penis, but this was not inhibited by cholinergic antagonists. Buflomedil (except at supra-therapeutic concentrations) exerted no effect on endothelin release by HUVECS. Buflomedil inhibited 45Ca2+ uptake by human platelets when stimulated with collagen and adrenaline, but not when stimulated with calcium ionophore A23187. These data demonstrate that buflomedil has no deleterious effect on the enzymes that control vascular PGI2 synthesis. The data also adds to the evidence that buflomedil is an alpha-adrenoceptor blocker and has stimulatory effects on penile PGI2 synthesis. Both of these properties may prove useful in the treatment of impotence. The specific inhibition of 45Ca2+ uptake consolidates that buflomedil has some calcium-channel-blocking properties which may explain, at least in part, its vasodilator and antiplatelet properties. Buflomedil may prove beneficial in the treatment of impotence via three mechanisms: (a) stimulation of penile PGI2 synthesis (b) alpha-adrenoceptor blockade and (c) calcium-mobilization-blocking properties.

Pretreatment with buflomedil enhances ventricular function by reducing the dysfunctional area after transient coronary artery occlusion.

OBJECTIVE: The aim was to evaluate whether buflomedil (a drug used to treat peripheral vascular disease and which has a number of pharmacological actions potentially beneficial to dysfunctional myocardium) would preserve myocardial function after transient coronary artery occlusion followed by reperfusion. METHODS: The physiological response to a 15 min balloon occlusion of the left anterior descending coronary artery followed by 1 h of reperfusion was monitored in 17 placebo treated dogs and compared with that of 15 dogs which received 10 mg.kg-1 of buflomedil. Buflomedil or its vehicle were given intravenously. Myocardial blood flow was assessed with radiolabelled microspheres and cardiac function was evaluated with quantitative contrast left ventriculography. RESULTS: Buflomedil did not affect baseline haemodynamic variables or contractile function. At the end of occlusion, there was no difference between dogs receiving vehicle compared with those receiving drug with respect to ejection fraction [33(SD 11)% v 34(11)%] or transmural blood flow [0.23(0.11) v 0.28(0.14) ml.g-1 x min-1]. However, at 30 min after reperfusion, ejection fraction was 89% of normal in the buflomedil group compared with 69% of normal in the placebo group (p < 0.03). This difference was sustained 60 min after reperfusion, and was due in part to slightly enhanced flow during reperfusion and a decrease in the dysfunctional area (16 compared with 28 chords lower than -2 SD from the mean, p < 0.04) in the hearts of dogs receiving buflomedil. Areas at risk were equivalent (15.9% and 15.8% of the left ventricle, respectively). CONCLUSIONS: The results suggest that buflomedil and agents with similar modes of action may be beneficial in preserving ventricular function after transient ischaemia followed by reperfusion.

[False failure of an aortocoronary bypass. Spasm of an artery revascularized by 2 saphenous vein graft]. / Faux échec du pontage aorto-coronaire. Spasme sur artère revascularisée par greffon veineux saphène.

The cause of recurrent resting angina one year after aorto-coronary bypass is presented. A 65 year old female with effort and resting angina with syncope had an isolated narrowing of the proximal portion of the left anterior descending artery on coronary angiography. Saphenous vein aorto-coronary bypass and cardiac plexectomy were performed on the 18 . 12 . 78, and an excellent result was obtained in the first postoperative year. Nocturnal angina with syncope recurred on the 31 . 12 . 79 and anterior subendo-cardial ischaemic changes were noted on the post critical electrocardiogramme. On control angiography 10 days later, the bypass graft was shown to be patent. A provocative test with methylergometrine showed spasm of the whole of the revascularised artery without any changes in the other vessels. Attacks of spontaneous angina with ST depression on Holter monitoring continued despite treatment with Nifedipine (6 capsules/day). The substitution of Diltiazem (3 capsules/day) prevented further recurrence with a follow-up of three months. The authors conclude that spontaneous angina after aorto-coronary bypass is not synonymous with graft dysfunction, and suggest that the effects of cardiac denervation in vasospastic angina, where Nifedipine and Diltiazem seem to have different modes of action, need further confirmation.