title: Repeated Remote Ischemic Conditioning Effect on Ankle-brachial Index in Diabetic Patients - A Randomized Control Trial.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) is a phenomenon where a short period of ischemia in one organ protects against further ischemia in the other organs. We hypothesized that RIPC occurring in diabetic patients with ankle brachial index (ABI) between 0.70 and 0.90 were included with peripheral arterial disease, would make the better coronary flow resulted in the increasing ABI.
  
  
  METHODS
  This randomized clinical trial study was done in the Afshar Cardiovascular Hospital in Yazd between 2013 and 2014. Sixty participants were randomly divided into two groups (intervention and control groups). The intervention group was undergoing RIPC, and the control group was tested without RIPC. RIPC was stimulated by giving three cycles of 5 min of ischemia followed by 5 min of reperfusion of both upper arms using a blood pressure cuff inflated to 200 mm Hg (n= 30). This was compared with no RIPC group which consisted of placing a deflated blood pressure cuff on the upper limbs (n= 30).
  
  
  RESULTS
  The mean of ABI level before intervention in the RIPC and control group group was 0.82 ± 0.055 and 0.83 ± 0.0603 (P= 0.347) respectively, with no significant difference. It was 0.86 ± 0.066 in the RIPC group compared the control 0.83 ± 0.0603 (P= 0.046). So levels of ABI were greater after intervention in the RIPC group. The mean of ABI level increase from 0.82 ± 0.05 to 0.86 ± 0.06 in RIPC group (P= 0.008). So the intervention group showed a significant increase in ABI.
  
  
  CONCLUSIONS
  RIPC through using a simple, noninvasive technique, composing three cycles of 5 min-ischemia of both upper arms, showing a significant increase in ABI level in diabetic patients.
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Najmeh
authors.initials: N
authors.lastname: Shahvazian
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Rafiee
authors.affiliation: Department of Endocrinology and Metabolism, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Rahmanian
authors.affiliation: Department of Nuclear Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Seyed Kazem
authors.initials: SK
authors.lastname: Razavi-Ratki
authors.affiliation: Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Hadi
authors.initials: MH
authors.lastname: Farahzadi
keywords: Ankle brachial index; peripheral arterial disease; remote ischemic preconditioning