Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair

Li, Cai; Li, Yunsheng; Xu, Ming; Wen, Sijian; Yao, Xi; Wu, Yan; Huang, Chanyan; Huang, Wenqi; Liu, Ke-Xuan

doi:10.1097/aln.0b013e3182850da5

Cited by 105 publications

(110 citation statements)

References 44 publications

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“…This observation is in line with several other studies, for example, (Li et al. ). Whether the decrease in ROS is the mechanism underlying RIPC‐induced protection remains, however, unclear from these data.…”

Section: Discussionsupporting

confidence: 94%

Remote ischemic preconditioning delays the onset of acute mountain sickness in normobaric hypoxia

et al. 2015

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Acute mountain sickness (AMS) is a neurological disorder occurring when ascending too fast, too high. Remote ischemic preconditioning (RIPC) is a noninvasive intervention protecting remote organs from subsequent hypoxic damage. We hypothesized that RIPC protects against AMS and that this effect is related to reduced oxidative stress. Fourteen subjects were exposed to 18 hours of normoxia (21% oxygen) and 18 h of normobaric hypoxia (12% oxygen, equivalent to 4500 m) on different days in a blinded, randomized order. RIPC consisted of four cycles of lower limb ischemia (5 min) and 5 min of reperfusion, and was performed immediately before the study room was entered. A control group was exposed to hypoxia (12% oxygen, n = 14) without RIPC. AMS was evaluated by the Lake Louise score (LLS) and the AMS-C score of the Environmental Symptom Questionnaire. Plasma concentrations of ascorbate radicals, oxidized sulfhydryl (SH) groups, and electron paramagnetic resonance (EPR) signal intensity were measured as biomarkers of oxidative stress. RIPC reduced AMS scores (LLS: 1.9 ± 0.4 vs. 3.2 ± 0.5; AMS-C score: 0.4 ± 0.1 vs. 0.8 ± 0.2), ascorbate radicals (27 ± 7 vs. 65 ± 18 nmol/L), oxidized SH groups (3.9 ± 1.4 vs. 14.3 ± 4.6 μmol/L), and EPR signal intensity (0.6 ± 0.2 vs. 1.5 ± 0.4 × 106) after 5 h in hypoxia (all P < 0.05). After 18 hours in hypoxia there was no difference in AMS and oxidative stress between RIPC and control. AMS and plasma markers of oxidative stress did not correlate. This study demonstrates that RIPC transiently reduces symptoms of AMS and that this effect is not associated with reduced plasma levels of reactive oxygen species.

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Section: Discussionsupporting

confidence: 94%

Remote ischemic preconditioning delays the onset of acute mountain sickness in normobaric hypoxia

et al. 2015

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“…Recently, a randomized controlled trial showed that remote IP powerfully counteracts the injury to the intestinal mucosa caused by a period of ischemia and subsequent reperfusion during elective open infrarenal abdominal aortic aneurysm repair [13] . Although intestinal protection with IP is a reproducible and powerful phenomenon, it has not been readily translated to routine clinical use.…”

Section: Discussionmentioning

confidence: 99%

“…Although restoration of blood flow to intestinal ischemic tissue is critical for tissue salvage, reperfusion also introduces inflammatory changes that exacerbate injury [12] . IP is a simple procedure conferring cytoprotection in critical organs that has clinical applications [13,14] . Although intestinal IP triggers powerful protective effects mechanisms by which it alleviates intestinal injury remain to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Ischemic preconditioning ameliorates intestinal injury induced by ischemia-reperfusion in rats

Wang

et al. 2015

WJG

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“…After reperfusion is performed, in such cases, reactive oxygen species are generated and there is excess production of pro-inflammatory molecules and a subsequent inflammatory response, which can lead to damage to internal organs, such as the lungs, liver, kidneys, intestines and heart, as well as death [ 1 ] . Multiple organ dysfunction occurring after abdominal aortic surgery is one of the major causes of mortality and morbidity, with 25% of the deaths that occur after elective abdominal aortic repair being related to multiple organ dysfunction [ 2 ] . Silymarin, which is a mixture of flavonoids and polyphenols, has been shown to exhibit a variety of pharmacological activities as well as antioxidant, anti-inflammatory, immunomodulatory, hepatoprotective, neuroprotective, renoprotective [against ischemia-reperfusion (I/R) injury], gastroprotective, antibacterial, antiviral, antithrombotic, and vasodilatory effects in many experimental and clinical studies [ 3 , 4 ] .…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal administration of silymarin protects end organs from multivisceral ischemia/reperfusion injury in a rat model

Koçarslan

Aydın

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveTo determine whether intraperitoneal silymarin administration has favorable effects on the heart, lungs, kidney, and liver and on oxidative stress in a rat model of supraceliac aorta ischemia/reperfusion injury.MethodsThirty male Wistar albino rats were divided equally into three groups: sham, control, and silymarin. The control and silymarin groups underwent supraceliac aortic occlusion for 45 min, followed by a 60 min period of reperfusion under terminal anesthesia. In the silymarin group, silymarin was administered intraperitoneally during ischemia at a dose of 200 mg/kg. Rats were euthanized using terminal anesthesia, and blood was collected from the inferior vena cava for total antioxidant capacity, total oxidative status, and oxidative stress index measurement. Lungs, heart, liver and kidney tissues were histologically examined.ResultsIschemia/reperfusion injury significantly increased histopathological damage as well as the total oxidative status and oxidative stress index levels in the blood samples. The silymarin group incurred significantly lesser damage to the lungs, liver and kidneys than the control group, while no differences were observed in the myocardium. Furthermore, the silymarin group had significantly lower total oxidative status and oxidative stress index levels than the control group.ConclusionIntraperitoneal administration of silymarin reduces oxidative stress and protects the liver, kidney, and lungs from acute supraceliac abdominal aorta ischemia/reperfusion injury in the rat model.

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Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair

Abstract: Limb RIPC attenuates intestinal and pulmonary injury in patients undergoing elective open infrarenal abdominal aortic aneurysm repair without any potential risk.

Cited by 105 publications

References 44 publications

Remote ischemic preconditioning delays the onset of acute mountain sickness in normobaric hypoxia

Remote ischemic preconditioning delays the onset of acute mountain sickness in normobaric hypoxia

Ischemic preconditioning ameliorates intestinal injury induced by ischemia-reperfusion in rats

Intraperitoneal administration of silymarin protects end organs from multivisceral ischemia/reperfusion injury in a rat model

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