Intraoperative skeletal muscle ischemia contributes to risk of renal dysfunction following thoracoabdominal aortic repair☆☆☆

Abstract

This is the first study to show a relationship between intraoperative leg ischemia and postoperative renal failure. It provides epidemiological evidence that the ischemic leg may be an important contributor to rhabdomyolysis-like renal morbidity after thoracoabdominal aortic surgery.

Inhibition of reactive oxygen species downregulates the MAPK pathway in rat spinal cord after limb ischemia reperfusion injury

“…In fact, Monsour et al showed that tourniquet-induced limb IR leads to mitochondrial dysfunction in thelung [20]. Miller et al demonstrated that ischemic leg is an important contributor to renal morbidity [21]. The results of several studies suggest that systemic events involving ROS and inflammatory cytokines may play a key role in the remote organ injury induced by limb IR [19,22].…”

Postoperative hyperkalemia

“…after successful surgery or endovascular procedures) not only mobilizes the potassium released from damaged cells, but the hyperkalemia is worsened by ischemia-induced acidosis. This is not infrequently encountered in patients having vascular surgery involving large arteries, such as those that require cross-clamping of the aorta [31], and can cause leg ischemia and muscle injury [34]. Ischemia and rhabdomyolysis have also been reported after tourniquet use for hemostasis in the trauma field or for a variety of orthopedic procedures, such as for the hip, ankle and foot [35,36].…”

Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair

“…[1][2][3][4][5] Several techniques have been tried in an attempt to decrease renal complications, including various methods of renal perfusion. [6][7][8][9] Our previous randomized clinical trial 10 compared two renal perfusates: cold crystalloid fluid (lactated Ringer's solution) and isothermic blood from the left heart bypass (LHB) circuit.…”