title: Vascular surgery-related organ injury and protective strategies: update and future prospects.
abstract: Whilst there has been a reduction in the prevalence of peripheral vascular disease worldwide, a significant proportion of the world's growing population is still affected by disease of the aorta, carotid, iliac and lower limb arteries. These if left untreated can result in severe morbidity and mortality. However vascular surgery, the main definitive treatment for such conditions, is associated with subsequent injury to vital organs including the kidneys, heart, brain, intestines and lungs, with a consequent increase in both morbidity and mortality. The current thinking is that the underlying mechanism of injury is direct organ ischaemia and ischaemia induced formation of free radicals, cytokine release and mitochondrial failure. Various methods to alleviate such injuries have been investigated including pre- and postconditioning strategies, pharmacological therapies including volatile anaesthetic and alpha2 adrenoceptor agonist drugs and more recently remote conditioning strategies. Although these interventions have demonstrated some reduction in the biomarkers for organ injury, attempts to translate these benefits into clinical practice have not been successful in terms of morbidity, mortality or length of hospital stay. For this reason, further research is needed in this area to facilitate the translation of the potential interventional benefits from bench to bedside.
authors: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors: B
authors: B
authors: Yang
authors: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors: A
authors: A
authors: Fung
authors: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer Imperial College London, Chelsea and Westminster Hospital, London, UK Department of Anaesthetics, Wycombe Hospital, Buckinghamshire Hospitals NHS Trust High Wycombe, Buckinghamshire, UK.
authors: C
authors: C
authors: Pac-Soo
authors: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer Imperial College London, Chelsea and Westminster Hospital, London, UK d.ma@imperial.ac.uk.
authors: D
authors: D
authors: Ma
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D055371:Acute Lung Injury / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005609:Free Radicals / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000209:etiology; D057775:Ischemic Postconditioning; D019194:Ischemic Preconditioning; D011183:Postoperative Complications / Q000209:etiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D005609:Free Radicals
keywords: mechanism of action; protective agents; surgical injuries; vascular surgery