title: Ischemic preconditioning versus intermittent vascular occlusion in liver resections performed under selective vascular exclusion: a prospective randomized study.
abstract: BACKGROUND
  The aim of this study was to compare ischemic preconditioning with the intermittent vascular occlusion technique in liver resections performed under inflow and outflow occlusion.
  
  
  METHODS
  Fifty-four patients with resectable liver tumors assigned were randomly to undergo surgery with either ischemic preconditioning (IP group, n = 27) or with intermittent vascular occlusion (IVO group, n = 27). Both groups were compared regarding surgical parameters, aspartate transaminase levels, and apoptosis.
  
  
  RESULTS
  For warm ischemic time less than 40 minutes, no significant difference was noticed between the 2 groups apart from caspase-3 activity, which was higher in the IVO group than in the IP group (17.2 +/- 3.4 vs. 10.3 +/- 5.2, P < .05). When warm ischemia exceeded 40 minutes, the IP group showed higher levels in blood aspartate transaminase levels on day 3 (442 +/- 178 IU/L vs. 305 +/- 104 IU/L, P < .05) and higher caspase-3 levels (26.5 +/- 5.7 count/high-power field [hpf] vs. 20.7 +/- 3.6 count/hpf, P < .05) and apoptotic activity (28.5 +/- 7.5 count/hpf vs. 20.2 +/- 4.1 count/hpf, P < .05), as compared with the IVO group.
  
  
  CONCLUSIONS
  Although both techniques showed comparable efficacy for short ischemic times, intermittent vascular occlusion provided better cytoprotection when ischemia exceeded 40 minutes.
authors.affiliation: Second Department of Surgery, University of Athens, School of Medicine, Areteion Hospital, 76 Vas. Sofias Av., 115 28, Athens, Greece. vsmyrniotis@hotmail.com
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
authors.forename: Kassiani
authors.initials: K
authors.lastname: Theodoraki
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Fragulidis
authors.forename: Agathi
authors.initials: A
authors.lastname: Condi-Pafiti
authors.forename: Matrona
authors.initials: M
authors.lastname: Plemenou-Fragou
authors.forename: Dionysios
authors.initials: D
authors.lastname: Voros
authors.forename: John
authors.initials: J
authors.lastname: Vassiliou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Dimakakos
mesh_terms: D017209:Apoptosis; D001219:Aspartate Aminotransferases / Q000097:blood; D003250:Constriction; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia; D019194:Ischemic Preconditioning; D008099:Liver / Q000098:blood supply* / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D001219:Aspartate Aminotransferases