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The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial.
Eur J Vasc Endovasc Surg 2019; 57(6):868-875EJ

Abstract

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 20-28 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 = .8), augmentation index corrected for heart rate of 75 beats per minute (p = .8), pulse wave velocity (p = .7), large artery elasticity indices (p = .8), small artery elasticity indices (p = .6), or mean arterial pressure (p = .7) changes between the RIPC and sham groups. There occurred statistically significant (p ≤ .01) improvement in augmentation index (-5.8% vs. -5.5%), augmentation index corrected for a heart rate of 75 beats per minute (-2.5% vs. -2%), 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. CLINICALTRIALS.GOV: NCT02689414.

Authors+Show Affiliations

Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia. Electronic address: teele.kepler@gmail.com.Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Estonia.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31126835

Citation

Kepler, Teele, et al. "The Effect of Remote Ischaemic Preconditioning On Arterial Stiffness in Patients Undergoing Vascular Surgery: a Randomised Clinical Trial." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 57, no. 6, 2019, pp. 868-875.
Kepler T, Kuusik K, Lepner U, et al. The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2019;57(6):868-875.
Kepler, T., Kuusik, K., Lepner, U., Starkopf, J., Zilmer, M., Eha, J., ... Kals, J. (2019). The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 57(6), pp. 868-875. doi:10.1016/j.ejvs.2018.12.002.
Kepler T, et al. The Effect of Remote Ischaemic Preconditioning On Arterial Stiffness in Patients Undergoing Vascular Surgery: a Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2019;57(6):868-875. PubMed PMID: 31126835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial. AU - Kepler,Teele, AU - Kuusik,Karl, AU - Lepner,Urmas, AU - Starkopf,Joel, AU - Zilmer,Mihkel, AU - Eha,Jaan, AU - Lieberg,Jüri, AU - Vähi,Mare, AU - Kals,Jaak, Y1 - 2019/05/22/ PY - 2018/08/15/received PY - 2018/12/01/accepted PY - 2019/5/28/pubmed PY - 2019/7/10/medline PY - 2019/5/26/entrez KW - Arteriosclerosis KW - Ischaemic preconditioning KW - Pulse wave analysis KW - Vascular stiffness KW - Vascular surgical procedures SP - 868 EP - 875 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 57 IS - 6 N2 - 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 20-28 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 = .8), augmentation index corrected for heart rate of 75 beats per minute (p = .8), pulse wave velocity (p = .7), large artery elasticity indices (p = .8), small artery elasticity indices (p = .6), or mean arterial pressure (p = .7) changes between the RIPC and sham groups. There occurred statistically significant (p ≤ .01) improvement in augmentation index (-5.8% vs. -5.5%), augmentation index corrected for a heart rate of 75 beats per minute (-2.5% vs. -2%), 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. CLINICALTRIALS.GOV: NCT02689414. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/31126835/The_Effect_of_Remote_Ischaemic_Preconditioning_on_Arterial_Stiffness_in_Patients_Undergoing_Vascular_Surgery:_A_Randomised_Clinical_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(18)30871-2 DB - PRIME DP - Unbound Medicine ER -