Preconditioning Shields Against Vascular Events in Surgery (SAVES)
Abdominal Aortic Aneurysm, Carotid Atherosclerosis, Critical Lower Limb Ischaemia
About this trial
This is an interventional prevention trial for Abdominal Aortic Aneurysm focused on measuring Vascular disease, Open aortic aneurysm repair, Endovascular aneurysm repair, Carotid endartrectomy, Lower limb surgical revascularisation, Major lower limb amputation
Eligibility Criteria
Inclusion Criteria:
- Age greater than 18 years
- patient willing to give full informed consent for participation
- Patients undergoing elective carotid endarterectomy or
- Patients undergoing open abdominal aortic aneurysm repair or
- Patients undergoing endovascular abdominal aneurysm repair or
- Patients undergoing surgical lower limb revascularisation (suprainguinal or infrainguinal)
Exclusion Criteria:
- Patients less than 18 years of age
- Patients who are unable or unwilling to give full informed consent
- Pregnancy
- Significant upper limb peripheral arterial disease
- Patients on glibenclamide or nicorandil (these medications may interfere with remote ischaemic preconditioning)
- Patients with an estimated pre-operative glomerular filtration rate < 30mls/min/1.73m2
- Patients with a history of myocarditis, pericarditis or amyloidosis
- Patients undergoing Fenestrated or branched EVAR.
Sites / Locations
- MidWestern Regional Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Remote preconditioning
Remote preconditioning control
Preconditioning will be performed in the same manner as several previous trials. Immediately after induction of anaesthesia, a standard, CE-approved blood pressure cuff will be placed around one arm of the patient. It will then be inflated to a pressure of 200mmHg for 5 minutes. For patients with a systolic blood pressure >185mmHg, the cuff will be inflated to at least 15mmHg above the patient's systolic blood pressure. The cuff will then be deflated and the arm allowed reperfuse for 5 minutes. This will be repeated so that each patient receives a total of 4 ischaemia-reperfusion cycles. In all other respects, the procedure and peri-operative care will follow the routine practices of the surgeons and anaesthetists involved.
Patients randomised to this group will receive routine pre-operative, peri-operative and post operative care.