title: A MultiCenter Pilot Randomized Controlled Trial of Remote Ischemic Preconditioning in Major Vascular Surgery.
abstract: A pilot randomized controlled trial that evaluated the effect of remote ischemic preconditioning (RIPC) on clinical outcomes following major vascular surgery was performed. Eligible patients were those scheduled to undergo open abdominal aortic aneurysm repair, endovascular aortic aneurysm repair, carotid endarterectomy, and lower limb revascularization procedures. Patients were randomized to RIPC or to control groups. The primary outcome was a composite clinical end point comprising any of cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac arrest, congestive cardiac failure, cerebrovascular accident, renal failure requiring renal replacement therapy, mesenteric ischemia, and urgent cardiac revascularization. Secondary outcomes were components of the primary outcome and myocardial injury as assessed by serum troponin values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14 (14.1%) of 99 RIPC group patients (P = .446). There were no significant differences in secondary outcomes. Our trial generated data that will guide future trials. Further trials are urgently needed.
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland donagh1@hotmail.com.
authors.forename: D A
authors.initials: DA
authors.lastname: Healy
authors.affiliation: Department of Surgery Cork, University Hospital, Cork, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Boyle
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: McCartan
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Bourke
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Medani
authors.affiliation: Department of Medicine, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Department of Medicine, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Yagoub
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Bashar
authors.affiliation: Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Newell
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Canning
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: McMonagle
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Dowdall
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Cross
authors.affiliation: Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: O'Daly
authors.affiliation: Department of Surgery Cork, University Hospital, Cork, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Manning
authors.affiliation: Department of Surgery Cork, University Hospital, Cork, Ireland.
authors.forename: G
authors.initials: G
authors.lastname: Fulton
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: E G
authors.initials: EG
authors.lastname: Kavanagh
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Burke
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: P A
authors.initials: PA
authors.lastname: Grace
authors.affiliation: Health Research Institute, University of Limerick, Limerick, Ireland.
authors.forename: M Clarke
authors.initials: MC
authors.lastname: Moloney
authors.forename: S R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D057510:Endovascular Procedures; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007494:Ireland; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D012039:Regional Blood Flow; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: aortic aneurysm; carotid endarterectomy; clinical trial; lower limb bypass; myocardial infarction; perioperative care; remote ischemic preconditioning; vascular surgery