OSA as a Remote Ischemic Preconditioning in Vascular Surgery
Study Details
Study Description
Brief Summary
Ischemia and reperfusion (I/R) injury during abdominal aortic aneurysm (AAA) repair is inevitable and may lead to postoperative multi-organ failure. Remote ischemic preconditioning (short periods of ischemia in anticipation of longer period of ischemia) may act protectively against ischemia.
Studies of ischemic preconditioning in patients with AAA are conflicting. Obstructive sleep apnea (OSA) is a sleep disordered breathing syndrome which may have a protective effect against ischemia.
The investigators hypothesize that I/R injury will be less pronounced in patients who have OSA and that the extent of I/R injury will inversely correlate with OSA severity. Accordingly, the aim of this study is to compare postoperative complications and markers of I/R in patients undergoing elective AAA repair who do and do not have OSA.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
Patients. Consecutive patients scheduled for elective aortobifemoral bypass (AAA and Leriche syndrome patients) will be recruited for this prospective, observational study.
Polygraphy (PG). PG measurements will be done two nights before surgery using the Embletta system (Embla - Embletta MPR PG Sleep Data Recording System).
STOP-BANG, Epworth questionnaire. Both questionnaires will be done the same day as polygraphy
Cardiovascular complications will be assessed from the first 30 post-operative days Pulmonary complications will be assessed from the first 30 post-operative days
Specific markers of I/R. T0 - before anesthesia induction T1 - 3 hrs after aorta de-clamping T2 - 12 hrs after aorta de-clamping T3 - 24 hrs after aorta de-clamping T4 - on the fifth post-operative day
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Obstructive Sleep Apnea Pacient with OSA (AHI≥5) undergoing aorto-bifemoral bypass |
Procedure: aorto-bifemoral bypass surgery
aorto-bifemoral bypass surgery (Leriche syndrom, elective AAA repair)
|
| Without Obstructive Sleep Apnea Patinets without OSA undergoing aorto-bifemoral bypass |
Procedure: aorto-bifemoral bypass surgery
aorto-bifemoral bypass surgery (Leriche syndrom, elective AAA repair)
|
Outcome Measures
Primary Outcome Measures
- Change of I/R injury markers [T0 - before anesthesia induction; T1 - 3 hrs after aorta de-clamping; T2 - 12 hrs after aorta de-clamping; T3 - 24 hrs after aorta de-clamping; T4 - on the fifth post-operative day]
Plasma Total Antioxidant Capacity and Reactive Oxygen Species Concentration
Secondary Outcome Measures
- post-operative complications [up to 30 post-operative days]
cardiovascular and pulmonary post-operative complications
Eligibility Criteria
Criteria
Inclusion Criteria:
- patients scheduled for elective aorto-bifemoral bypass (AAA and Leriche syndrome patients)
Exclusion Criteria:
-
emergent surgery
-
aorto-bifemoral bypass using deep vein graft
-
re-operations
-
known OSA with CPAP treatment
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | St. Anne's University Hospital Brno | Brno | Czech Republic | Czechia | 65691 |
Sponsors and Collaborators
- St. Anne's University Hospital Brno, Czech Republic
- Masaryk University
Investigators
- Principal Investigator: Ivan Cundrle, M.D., Ph.D., St. Anne's University Hospital in Brno
Study Documents (Full-Text)
None provided.More Information
Publications
- De Freitas S, Hicks CW, Mouton R, Garcia S, Healy D, Connolly C, Thomas KN, Walsh SR. Effects of Ischemic Preconditioning on Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. J Surg Res. 2019 Mar;235:340-349. doi: 10.1016/j.jss.2018.09.049. Epub 2018 Nov 13.
- Garcia S, Rector TS, Zakharova M, Herrmann RR, Adabag S, Bertog S, Sandoval Y, Santilli S, Brilakis ES, McFalls EO. Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES): A Prospective, Randomized, Sham-Controlled Phase II Clinical Trial. J Am Heart Assoc. 2016 Sep 29;5(10). pii: e003916.
- Healy DA, Boyle E, McCartan D, Bourke M, Medani M, Ferguson J, Yagoub H, Bashar K, O'Donnell M, Newell J, Canning C, McMonagle M, Dowdall J, Cross S, O'Daly S, Manning B, Fulton G, Kavanagh EG, Burke P, Grace PA, Moloney MC, Walsh SR; Preconditioning Shields Against Vascular Events in Surgery (Preconditioning SAVES) Trial Group. A MultiCenter Pilot Randomized Controlled Trial of Remote Ischemic Preconditioning in Major Vascular Surgery. Vasc Endovascular Surg. 2015 Nov;49(8):220-7. doi: 10.1177/1538574415614404. Epub 2015 Nov 16.
- Katseni K, Chalkias A, Kotsis T, Dafnios N, Arapoglou V, Kaparos G, Logothetis E, Iacovidou N, Karvouni E, Katsenis K. The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair. Biomed Res Int. 2015;2015:598980. doi: 10.1155/2015/598980. Epub 2015 Dec 21. Review.
- Li C, Li YS, Xu M, Wen SH, Yao X, Wu Y, Huang CY, Huang WQ, Liu KX. Limb remote ischemic preconditioning for intestinal and pulmonary protection during elective open infrarenal abdominal aortic aneurysm repair: a randomized controlled trial. Anesthesiology. 2013 Apr;118(4):842-52. doi: 10.1097/ALN.0b013e3182850da5. Erratum in: Anesthesiology. 2019 Jul;131(1):222.
- Mouton R, Pollock J, Soar J, Mitchell DC, Rogers CA. Remote ischaemic preconditioning versus sham procedure for abdominal aortic aneurysm repair: an external feasibility randomized controlled trial. Trials. 2015 Aug 25;16:377. doi: 10.1186/s13063-015-0899-3.
- Murphy N, Vijayan A, Frohlich S, O'Farrell F, Barry M, Sheehan S, Boylan J, Conlon N. Remote ischemic preconditioning does not affect the incidence of acute kidney injury after elective abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2014 Oct;28(5):1285-92. doi: 10.1053/j.jvca.2014.04.018.
- Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986 Nov;74(5):1124-36.
- Sánchez-de-la-Torre A, Soler X, Barbé F, Florés M, Maisel A, Malhotra A, Rue M, Bertran S, Aldomá A, Worner F, Valls J, Lee CH, Turino C, Galera E, de Batlle J, Sánchez-de-la-Torre M; Spanish Sleep Network(∗). Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study. Chest. 2018 Feb;153(2):329-338. doi: 10.1016/j.chest.2017.06.046. Epub 2017 Jul 20.
- Shah N, Redline S, Yaggi HK, Wu R, Zhao CG, Ostfeld R, Menegus M, Tracy D, Brush E, Appel WD, Kaplan RC. Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning? Sleep Breath. 2013 May;17(2):819-26. doi: 10.1007/s11325-012-0770-7. Epub 2012 Oct 23. Erratum in: Sleep Breath. 2013 Sep;17(3):1119.
- Thomas KN, Cotter JD, Williams MJ, van Rij AM. Repeated Episodes of Remote Ischemic Preconditioning for the Prevention of Myocardial Injury in Vascular Surgery. Vasc Endovascular Surg. 2016 Apr;50(3):140-6. doi: 10.1177/1538574416639150. Epub 2016 Apr 12.
- Walsh SR, Boyle JR, Tang TY, Sadat U, Cooper DG, Lapsley M, Norden AG, Varty K, Hayes PD, Gaunt ME. Remote ischemic preconditioning for renal and cardiac protection during endovascular aneurysm repair: a randomized controlled trial. J Endovasc Ther. 2009 Dec;16(6):680-9. doi: 10.1583/09-2817.1.
- Walsh SR, Sadat U, Boyle JR, Tang TY, Lapsley M, Norden AG, Gaunt ME. Remote ischemic preconditioning for renal protection during elective open infrarenal abdominal aortic aneurysm repair: randomized controlled trial. Vasc Endovascular Surg. 2010 Jul;44(5):334-40. doi: 10.1177/1538574410370788. Epub 2010 May 18.
- IIT/2019/25