The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial

Abstract

WHAT THIS PAPER ADDS The current study is the first clinical study to examine the effect of remote ischaemic preconditioning (RIPC) on arterial stiffness in patients undergoing vascular surgery. Although this study failed to demonstrate a significant effect of RIPC on the arterial stiffness parameters, there was marked improvement in arterial stiffness parameters after surgery in both the interventional and the non-interventional (sham) groups. The finding that surgery itself may have an influence on arterial stiffness has some clinical impact. Objectives: The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on arterial stiffness in patients undergoing vascular surgery. Methods: This was a randomised, sham controlled, double blind, single centre study. Patients undergoing open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery or carotid endarterectomy were recruited. A RIPC or a sham procedure was performed, using a blood pressure cuff, along with preparation for anaesthesia. The RIPC protocol consisting of four cycles of 5 min of ischaemia, followed by 5 min of reperfusion was applied. Arterial stiffness and haemodynamic parameters were measured pre-operatively and 20e28 h after surgery. Two primary outcomes were selected: augmentation index and pulse wave velocity. Results: Ninety-eight patients were randomised. After dropouts 44 and 46 patients were included in the RIPC and sham groups, respectively. Both groups were comparable. There were no statistically significant differences in augmentation index (p ¼ .8), augmentation index corrected for heart rate of 75 beats per minute (p ¼ .8), pulse wave velocity (p ¼ .7), large artery elasticity indices (p ¼ .8), small artery elasticity indices (p ¼ .6), or mean arterial pressure (p ¼ .7) changes between the RIPC and sham groups. There occurred statistically significant (p .01) improvement in augmentation index (À5.8% vs. À5.5%), augmentation index corrected for a heart rate of 75 beats per minute (À2.5% vs. À2%), small artery elasticity indices (0.7 mL/mmHg  100 vs. 0.9 mL/mmHg  100), and mean arterial pressure post-operatively in both the RIPC and the sham groups (change median values in RIPC and sham groups, respectively). Conclusions: RIPC had no significant effect on arterial stiffness, but there was significant improvement in arterial stiffness after surgery in both groups. Arterial stiffness and haemodynamics may be influenced by surgery or anaesthesia or oxidative stress or all factors combined. Further studies are needed to clarify these findings.

Remote ischaemic preconditioning influences the levels of acylcarnitines in vascular surgery: a randomised clinical trial

“…All patients were asked about their previous and current health issues and medications; an electronic health database was also used for complete anamnesis. As the study's primary outcomes were parameters of arterial stiffness, calculation of sample size was based on their values [12]. For both groups, calculated sample size was 44.…”

Remote Ischaemic Preconditioning Reduces Kidney Injury Biomarkers in Patients Undergoing Open Surgical Lower Limb Revascularisation: A Randomised Trial

“…For achieving ischaemia, pressure in the blood pressure cuff was raised for 5 minutes to 200 mmHg or, when the patient's blood pressure exceeded 180 mmHg, to a value that was 20 mmHg higher than the value of systolic blood pressure. In the sham group, pressure in the cuff was equal to venous pressure (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Between all episodes, there was a 5-minute period of reperfusion.…”

“…This is a substudy within our large clinical trial conducted for evaluating the effect of RIPC on vascular stiffness and end-organ damage [14,15]. Among our secondary aims was to investigate changes in the levels of traditional and novel kidney function biomarkers and markers of inflammation and OxS.…”

Remote Ischaemic Preconditioning in Vascular Surgery: Is it Worth the Effort?

“…Kepler et al reported the results of a randomised, sham controlled, double blind, single centre trial in which 90 patients who underwent vascular surgery were included in a group that received remote ischaemic preconditioning (RIPC) or into a sham group. 1 In the RIPC group, four cycles of five minutes of ischaemia and five minutes of reperfusion were administered using a blood pressure cuff placed on one arm, before open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery, or carotid endarterectomy. As compared with the sham group, RIPC had no effect on primary outcomes, defined as augmentation index and aortic pulse wave velocity, both measured pre-operatively and 20e28 h after surgery.…”

“…The results of Kepler et al focusing on the effect of RIPC on arterial stiffness are very interesting. 1 It is based on an "all comers" approach leading to the randomisation of a relatively large population over a short period of time. This "all comers" design may have facilitated recruitment of a larger cohort than would have been possible if it focused on one type of procedure.…”