title: Does the sequence of clamp application during open abdominal aortic aneurysm surgery influence distal embolisation?
abstract: BACKGROUND
  Embolisation of atherosclerotic debris during abdominal aortic aneurysm (AAA) repair is responsible for significant peri-operative morbidity. Reports have suggested that preferential clamping of the distal vessel(s) before the proximal aorta may decrease the number of emboli passing distally and hence reduce complications.
  
  
  METHODS
  Forty patients undergoing AAA repair were randomised to have either first clamping of the proximal aorta or the iliac vessels. Emboli passing through the Superficial Femoral Arteries were detected with a Transcranial Doppler ultrasound system.
  
  
  RESULTS
  There was no difference between the two groups in the number of emboli detected (p=0.49) and no significant correlation between number of emboli and dissection time (r=0.0008). However, there was a significantly higher number of emboli in the patient sub-group that were current smokers (p=0.034).
  
  
  CONCLUSIONS
  There appears to be no difference in the numbers of emboli detected when the first vascular clamp is applied to the proximal aorta or iliacs.
authors.affiliation: Department of Vascular Surgery, Leicester Royal Infirmary, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Webster
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P R F
authors.initials: PR
authors.lastname: Bell
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D004617:Embolism / Q000209:etiology*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*