Remote ischemic preconditioning in major vascular surgery.
Remote ischemic preconditioning is a physiologic mechanism in mammalian species whereby brief exposure to nonlethal ischemia in one tissue confers protection against a prolonged ischemic insult in a distant tissue. First described almost 15 years ago, it has been slow to translate into clinical practice. Several clinical trials have recently reported that remote ischemic preconditioning reduces myocardial injury after major cardiovascular surgery. In addition, a randomized trial in patients undergoing open abdominal aortic aneurysm repair reported a significant reduction in perioperative myocardial infarctions. Remote ischemic preconditioning is easily performed and likely to prove highly cost-effective. large-scale trials of the technique are warranted in patients undergoing major vascular surgery.
Walsh
Stewart R
SR
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Tang
Tjun Y
TY
Sadat
Umar
U
Gaunt
Michael E
ME
D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D006801:Humans; D019194:Ischemic Preconditioning; D019157:Ischemic Preconditioning, Myocardial; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D015398:Signal Transduction; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*