Effects of Ischemic Preconditioning on Clinical Outcomes in Abdominal Aortic Aneurysm Repair: Systematic Review and Meta-Analysis
Simon De Freitas, MD1, Caitlin W. Hicks, MD1, Stewart R. Walsh, MD2.
1Johns Hopkins, Baltimore, MD, USA, 2National University of Ireland, Galway, Galway, Ireland.
OBJECTIVES: Ischemic preconditioning is an innate mechanism of cytoprotection against ischemia, with potential for end organ protection. The primary goal of this study was to systematically review the literature to determine the effect of ischemic preconditioning on outcomes after open and endovascular abdominal aortic aneurysm (AAA) repair.
METHODS: The methodology followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We included randomized clinical trials that evaluated the effect of remote ischemic preconditioning (RIPC) in reducing morbidity and mortality in patients undergoing open or endovascular AAA repair surgery. The primary outcomes were death, myocardial infarction and renal impairment. Outcomes were addressed separately for open AAA repair and endovascular AAA repair (EVAR). Data were collected on patient characteristics, methodology and preconditioning protocol for each trial.
RESULTS: Nine trials of ischemic preconditioning in aortic aneurysm surgery were included with a total of 599 patients; 336 patients were included in the open AAA repair meta-analysis and 263 patients were included in the EVAR meta-analysis. For both open and endovascular repairs, ischaemic preconditioning did not have a significant effect on death, myocardial infarction or renal impairment.
CONCLUSION: The randomized clinical trials completed to date have not been adequately powered to evaluate improvements in patient-important outcomes. The evidence is insufficient to support the use of ischemic preconditioning in clinical practice. The variability in treatment effect across studies may be explained by clinical and methodological heterogeneity.
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