Organ protection during aortic cross-clamping

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• 作者：Kak Khee Yeung ; MD ; PhD^a ; ^b ; ^c ; ^{k.yeung@vumc.nl" class="auth_mail" title="E-mail the corresponding author} (Senior Resident Vascular Surgery ; Research Coordinator) ; Menno Groeneveld ; MD^a ; ^b ; ^c ; ^{me.groeneveld@vumc.nl" class="auth_mail" title="E-mail the corresponding author} (Resident Surgery ; PhD Student) ; Joyce Ja-Ning Lu ; MD^d ; ^{joycejlu@gmail.com" class="auth_mail" title="E-mail the corresponding author} (Resident Vascular Surgery) ; Pepijn van Diemen ; BSc^a ; ^{pepijn_van_diemen@hotmail.com" class="auth_mail" title="E-mail the corresponding author} (Junior Researcher) ; Vincent Jongkind ; MD ; PhD^a ; ^{v.jongkind@vumc.nl" class="auth_mail" title="E-mail the corresponding author} (Vascular Surgeon) ; Willem Wisselink ; MD ; PhD^a ; ^{w.wisselink@vumc.nl" class="auth_mail" title="E-mail the corresponding author} (Professor of Vascular Surgery ; Vascular Surgeon)
• 关键词：abdominal aortic aneurysm ; aortic aneurysm repair surgery ; aortic cross-clamping ; ischemia-reperfusion injury ; acute kidney injury ; colonic ischemia ; therapeutic organ hypothermia
• 刊名：Best Practice Research Clinical Anaesthesiology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：30
• 期：3
• 页码：305-315
• 全文大小：774 K

文摘

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.