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Best Pract Res Clin Anaesthesiol. 2016 Sep;30(3):305-15. doi: 10.1016/j.bpa.2016.07.005. Epub 2016 Aug 20.

Organ protection during aortic cross-clamping.

Author information

1
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands; ACS, Amsterdam Cardiovascular Research Sciences, The Netherlands. Electronic address: k.yeung@vumc.nl.
2
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands; ACS, Amsterdam Cardiovascular Research Sciences, The Netherlands. Electronic address: me.groeneveld@vumc.nl.
3
Grand Rapids Medical Education Partners, MI, USA. Electronic address: joycejlu@gmail.com.
4
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: pepijn_van_diemen@hotmail.com.
5
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: v.jongkind@vumc.nl.
6
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.wisselink@vumc.nl.

Abstract

Open surgical repair of an aortic aneurysm requires aortic cross-clamping, resulting in temporary ischemia of all organs and tissues supplied by the aorta distal to the clamp. Major complications of open aneurysm repair due to aortic cross-clamping include renal ischemia-reperfusion injury and postoperative colonic ischemia in case of supra- and infrarenal aortic aneurysm repair. Ischemia-reperfusion injury results in excessive production of reactive oxygen species and in oxidative stress, which can lead to multiple organ failure. Several perioperative protective strategies have been suggested to preserve renal function during aortic cross-clamping, such as pharmacotherapy and therapeutic hypothermia of the kidneys. In this chapter, we will briefly discuss the pathophysiology of ischemia-reperfusion injury and the preventative measures that can be taken to avoid abdominal organ injury. Finally, techniques to minimize the risk of complications during and after open aneurysm repair will be presented.

KEYWORDS:

abdominal aortic aneurysm; acute kidney injury; aortic aneurysm repair surgery; aortic cross-clamping; colonic ischemia; ischemia-reperfusion injury; therapeutic organ hypothermia

PMID:
27650341
DOI:
10.1016/j.bpa.2016.07.005
[Indexed for MEDLINE]

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