The "no-reflow" phenomenon may occasionally be encountered when blood flow has been re-established to an end-organ after a prolonged period of ischemia.


The no-reflow phenomenon may occur with:

(1) reattachment of amputated limbs

(2) reperfusion into ischemic limbs

(3) following a myocardial infarction with coronary artery occlusion

(4) following organ transplantation

(5) stroke due to vascular occlusion



(1) Blood flow is re-established following a prolonged period of ischemia (usually more than 60 minutes).

(2) Although there is blood flow in major blood vessels, there is no tissue perfusion, which may be demonstrated by a dye or other marker.

(3) There is no evidence of occlusion or thrombosis in the major blood vessels.


Theories for development of microvascular obstruction:

(1) thrombosis or microemboli in small blood vessels

(2) sludging of platelets and white blood cells along endothelial cells in small blood vessels

(3) endothelial cell swelling

(4) interstitial edema compressing small blood vessels

(5) spasm in small blood vessels

(6) vasoconstriction in small blood vessels


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