Cardiovascular diseases such as coronary artery are some of the leading causes of mortality in the world that occurs as a manifestation of ischemic heart disease. Ischemic conditions arise from occlusion of a cerebral artery that may result in an irreversible death of a tissue organ ( McFalls et al., 2004) . It develops when the blood flow and delivery of oxygen to the tissues are restricted, leading to pain and tissue or organ damage. The blood flow restriction may be caused by a blood clot inside the vein or artery, thus obstructing enough oxygen and other nutrients to get to body tissues and organs.
Treatment methods for this condition include blood-thinning medications or through surgical means with the two main approaches being vascular bypass and angioplasty. The surgical procedures are known as revascularization, which refers to the restoration of perfusion to an organ that has suffered ischemia in medical and surgical therapy ( McFalls et al., 2004) . Revascularization looks to restore the flow of blood by placing new blood vessels around the existing blockages to restore the necessary blood flow. It is used alongside preventive medical therapies and lifestyle changes to reduce ischemia and alleviate angina can help in improving the quality of life.
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However, bypass surgery can be performed on only 50 percent of the patients, which means the rest of the patients cannot undergo the operation due to the comorbidities of appropriate vessels to be vascularized. As a result, alternative perfusion strategies are needed to enhance the revascularization. Perfusion is the passage of fluid to organs in the body through the circulatory or lymphatic system ( Eggum et al., 2008) . Organs and tissues in the body require an adequate supply of blood to function, which means inadequate perfusion may cause problems in the functioning of the body as seen in the cardiovascular diseases. During significant surgery including revascularization, there is need to maintain the perfusion rather than leaving the body’s homeostasis alone. Patients with ischemic limbs or extremely poor perfusion are susceptible to such injuries, which is why there is need to enhance the perfusion during and after revascularization in patients ( Eggum et al., 2008) .
A good number of patients have conditions that require revascularization. However, due to the availability of some illnesses that is not amenable to the traditional revascularization, there is need to apply different techniques that act as complementary and alternative methods to help in the perfusion. Several techniques can enhance revascularization through different perfusion patterns
Bair Hugger
Bair hugger is a technique that can help in restoring perforation by maintaining the perfusion temperature. During revascularization, there is a need to keep a warm Perfusion temperature as an important factor in enhancing the recovery from revascularization. A certain level of coldness can have an adverse neurological impact on the patient while extreme temperatures may also not be sustainable ( Eggum et al., 2008). As a result, maintaining the perfusion temperature can enhance the procedure and increase the healing process of the patient. Any altered perfusion procedures, for example, involving the temperatures can lead to poor outcomes in critically ill patients by causing severe complications.
Bair hugger helps in maintaining the body temperature of the patient to promote a sustainable environment for perfusion. The technique involves using a Bair hugger as a convective warming therapy to transfers heat to patients by blowing warm air through micro-perforations ( Huang et al., 2003) . Bair huggers are intended to provide patient thermal comfort in case some conditions may cause the patient to become too warm or too cold. It is a kind of temperature management system used to treat and prevent hypothermia in patients. The huggers deliver air temperature requirements for a valid perfusion exercise. They are also used in preventing any airborne contaminations that result from air migrating towards the surgical site. They are designed in a way to filter the air to remove any chance of pathogens.
Actively warming throughout the surgical procedure is essential to enhance the vasodilation and maintain the blood pressure of the patient. Failing to warm a patient during and after performing the revascularization surgery can result in adverse outcomes and surgical site infections such impaired tissue perfusion, increase in blood loss or cardiac events ( Huang et al., 2003) .
Leech Therapy
Away from the Bair huggers, another technique that can facilitate smooth perfusion in the body is the use of leech therapy. This is an old age technique that has been used in medicine to treat abnormalities in the nervous system, dental problems or skin infections. Today, the therapy is integrated into plastic surgery to secret peptides and proteins that prevent blood clots and keeps blood from flowing to the wounds to help them heal ( Chepeha et al., 2002) . Despite being an ancient practice, the leech therapy is still a powerful way of enhancing revascularization and perfusion operations. The technique involves physicians setting leaches on a patient to such blood and prevents blood clots and dying tissues. The saliva of the organisms contains anticoagulant hirudin among other chemicals that reduce the swelling and promotes healing.
Leeches are small organisms that attach on animals to such small amounts of blood for food. The medical leeches work by piercing the skin to insert the teeth and extracting blood from the area affected by a blood clot ( Singh, 2010). Leeches secrete more than 20 identifiable bioactive substances from the blood because of the components of their saliva. The saliva helps to reduce the viscosity of blood making it consistently thinner to promote better blood flow. By reducing the thickness, the saliva reduces the chances of a blood clot forming in the blood vessel to cause heart conditions. In reconstructive surgery, leeches may be used to improve blood flow in a tissue area or body organ that has poor blood circulation. They function by removing the clotted blood from the delicate areas, thus restarting blood flow in the small blood vessel. This is crucial in preventing the tissue from dying. Apart from removing the clotted blood, the saliva from leeches has an anesthetic aspect of reducing pain, a vasodilator aspect to improve blood supply as well as hirudin to prevent further clotting of the blood ( Singh, 2010) .
Several studies have shown that leech therapy can cause positive outcomes in blood circulation. For example, the therapy maintains the blood drainage after the leech has dropped off the body, which means it can continue to flow to areas that previously had poor circulation. The technique is a simple and inexpensive means of preventing complications and can be applied in perfusions. It is cheap, efficient and easy to apply, and is useful when used as a complementary rather than choice for perfusion. It can be used to treat blood clots and varicose veins and can be applied to patients who would risk limb amputations due to the side effects of undergoing cosmetic surgery anticoagulants ( Singh, 2010) .
Vasodilators
Using vasodilators is another technique that can be utilized in perfusion and enhance revascularization is through the use of vasodilators. These are endogenous drugs used in the treatment of cardiovascular diseases by dilating the open blood vessels to allow blood to flow more smoothly ( Zoghbi, Dorfman & Iskandrian, 2008) . They function by opening blood vessels and allowing blood flow, preventing the walls from narrowing. The dictionary defines vasodilation as the widening of the blood vessels resulting from relaxation of smooth muscle cells in the vessel walls. When the blood vessels dilate, they increase the flow of blood by reducing the vascular resistance, thus decreasing the blood pressure. The vaso-activity helps in keeping the body to run usually. These drugs are highly effective when used to manage hypertension. They function by relaxing the vascular smooth muscle to cause the vasodilation,
These vasodilator drugs can help in enhancing revascularization by allowing for more natural perfusion and restoring the flow of blood ( Zoghbi, Dorfman & Iskandrian, 2008). This is why these drugs are used in the treatment of hypertension, heart failure, and angina. Organ perfusion is mostly dependent on the pressure in the blood vessels that is determined by vascular resistance as well as the blood flow distribution. The vascular resistance is described by the obstruction of blood flow in the veins. Vasodilators work by reducing the total vascular resistance and can be used to control the blood pressure during and after surgery. When given during cardiopulmonary bypass, the drugs reduce systemic vascular resistance to improve the perfusion in the region and facilitate core cooling and rewarming.
There are different types of vasodilators including minoxidil and hydralazine. Hydralazine is a direct acting vasodilator that is highly selective for arterial resistance vessels though they also function as balanced dilators. Angiotensin-converting enzyme inhibitors can also be taken as vasodilators to dilate the blood vessels and control the blood pressure in the body. Most vasodilators are balanced to dilate both arteries and veins in the body and therefore have broad application in dealing with the heart conditions ( Sica & Gehr, 2001) . Another way to enhance the revascularization involves avoiding the vasoconstrictors, including caffeine that causes the blood vessels to shrink, thus affecting the flow of blood. Vasoconstrictors are the opposite of vasodilators.
In conclusion, several other techniques can be used to enhance the perfusion process in the blood as alternative and complementary methods of revascularization. Some of the ways include using Brail huggers to maintain the temperatures and complement the revascularization process, using leech therapy as an alternative method of doing perfusion as well as incorporating vasodilators in the revascularization process. Additionally, using vasodilators requires that patients avoid vasoconstrictors such as caffeine and nicotine.
References
Chepeha, D. B., Nussenbaum, B., Bradford, C. R., & Teknos, T. N. (2002). Leech therapy for patients with surgically unsalvageable venous obstruction after revascularized free tissue transfer. Archives of Otolaryngology–Head & Neck Surgery , 128 (8), 960-965.
Eggum, R., Ueland, T., Mollnes, T. E., Videm, V., Aukrust, P., Fiane, A. E., & Lindberg, H. L. (2008). Effect of perfusion temperature on the inflammatory response during pediatric cardiac surgery. The Annals of thoracic surgery , 85 (2), 611-617.
Huang, J. K., Shah, E. F., Vinodkumar, N., Hegarty, M. A., & Greatorex, R. A. (2003). The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk?. Critical Care , 7 (3), R13.
McFalls, E. O., Ward, H. B., Moritz, T. E., Goldman, S., Krupski, W. C., Littooy, F., ... & Shunk, K. (2004). Coronary-artery revascularization before elective major vascular surgery. New England Journal of Medicine , 351 (27), 2795-2804.
Sica, D. A., & Gehr, T. W. (2001). Direct vasodilators and their role in hypertension management: Minoxidil. The Journal of Clinical Hypertension , 3 (2), 110-114.
Singh, A. P. (2010). Medicinal leech therapy (hirudotherapy): a brief overview. Complementary therapies in clinical practice , 16 (4), 213-215.
Zoghbi, G. J., Dorfman, T. A., & Iskandrian, A. E. (2008). The effects of medications on myocardial perfusion. Journal of the American College of Cardiology , 52 (6), 401-416.
